Higher Heart Research Articles

Minimal Detectable Change Scores and Factors Associated With Dynamic Exertion Test (EXiT) Performance After Sport-Related Concussion.

Factors associated with performance outside of a normative range on dynamic exertion test (EXiT) after sport-related concussion (SRC) remain unknown. This study examined the role of demographic and medical history factors on performance using minimal detectable change (MDC) cutoff scores in athletes being cleared to return to sport (RTS) from SRC. Older age, being female, and body mass index (BMI) ≥50th percentile would be associated with worse EXiT performance and with increased likelihood of falling outside the normative MDC score range. Cross-sectional. Level 3. Demographic factors, physiological metrics, performance metrics, symptoms, and ratings of perceived exertion were collected from 55 participants (age, 16.5 ± 2.3 years, 31.5% female) initially evaluated within 14 days of SRC who completed EXiT at medical clearance for RTS. Chi-square analyses, logistic and ordinal regressions, and 1-way analyses of variance examined factors associated with EXiT performance. Most participants fell within the MDC score range on aerobic (71.2-100%), dynamic (75.8-100%), and change-of-direction (36.5-98.0%) tasks, and symptoms (96.2-100%). Older age was associated with better performance on Box Drill Shuffle (P < 0.01) and lower heart rate (HR) outcomes after Ball Toss (P = 0.04), Box Drill Shuffle (P < 0.01), Box Drill Carioca (P = 0.04), and Pro Agility (P < 0.01). Greater BMI was associated with higher HR%max after Ball Toss (P < 0.01) and worse posttreadmill aerobic performance (P < 0.01). Motion sickness history was associated with longer Zig Zag completion time (P = 0.036). Most athletes presenting for clearance from concussion performed within MDC score ranges on EXiT metrics. EXiT is accurate and effective in assessing response to dynamic exertion after SRC, and MDC scores can inform RTS decisions. Clinicians should consider age, BMI, and history of motion sickness when assessing EXiT performance.

Evaluation of a New Mobile Virtual Reality Setup to Alter Pain Perception: Pilot Development and Usability Study in Healthy Participants.

Chronic pain presents a significant treatment challenge, often leading to frustration for both patients and therapists due to the limitations of traditional methods. Research has shown that synchronous visuo-tactile stimulation, as used in the rubber hand experiment, can induce a sense of ownership over a fake body part and reduces pain perception when ownership of the fake body part is reported. The effect of the rubber hand experiment can be extended to the full body, for example, during the full-body illusion, using both visuo-tactile and cardiovisual signals. This study first aimed to evaluate the usability and accuracy of a novel, mobile virtual reality (VR) setup that displays participants' heartbeats as a flashing silhouette on a virtual avatar, a technique known as the cardiovisual full-body illusion. The second part of the study investigated the effects of synchronous cardiovisual stimulation on pain perception and ownership in 20 healthy participants as compared with asynchronous stimulation (control condition). The setup comprised a head-mounted display (HMD) and a heart rate measurement device. A smartphone-based HMD (Samsung Galaxy S8+) was selected for its mobility, and heart rates were measured using smartwatches with photoplethysmography (PPG). The accuracy of 2 smartwatch positions was compared with a 5-point electrocardiogram (ECG) standard in terms of their accuracy (number and percent of missed beats). Each participant underwent two 5-minute sessions of synchronous cardiovisual stimulation and two 5-minute sessions of asynchronous cardiovisual stimulation (total of 4 sessions), followed by pain assessments. Usability, symptoms of cybersickness, and ownership of the virtual body were measured using established questionnaires (System Usability Scale, Simulator Sickness Questionnaire, Ownership Questionnaire). Pain perception was assessed using advanced algometric methods (Algopeg and Somedic algometer). Results demonstrated high usability scores (mean 4.42, SD 0.56; out of 5), indicating ease of use and acceptance, with minimal side effects (mean 1.18, SD 0.46; out of a possible 4 points on the Simulator Sickness Questionnaire). The PPG device showed high heart rate measurement precision, which improved with optimized filtering and peak detection algorithms. However, compared with previous work, no significant effects on body ownership and pain perception were observed between the synchronous and asynchronous conditions. These findings are discussed in the context of existing literature on VR interventions for chronic pain. In conclusion, while the new VR setup showed high usability and minimal side effects, it did not significantly affect ownership or pain perception. This highlights the need for further research to refine VR-based interventions for chronic pain management, considering factors like visual realism and perspective.

Utilizing deep learning-based causal inference to explore vancomycin's impact on continuous kidney replacement therapy necessity in blood culture-positive intensive care unit patients.

Patients with positive blood cultures in the intensive care unit (ICU) are at high risk for septic acute kidney injury requiring continuous kidney replacement therapy (CKRT), especially when treated with vancomycin. This study developed a machine learning model to predict CKRT and examined vancomycin's impact using deep learning-based causal inference. We analyzed ICU patients with positive blood cultures, utilizing the Medical Information Mart for Intensive Care III data set. The primary outcome was defined as the initiation of CKRT during the ICU stay. The machine learning models were developed to predict the outcome. The deep learning-based causal inference model was utilized to quantitatively demonstrate the impact of vancomycin on the probability of CKRT initiation. Logistic regression was performed to analyze the relationship between the variables and the susceptibility of vancomycin. A total of 1,318 patients were included in the analysis, with 41 requiring CKRT. The Random Forest and Light Gradient Boosting Machine exhibited the best performance, with Area Under Curve of Receiver Operating Characteristic Curve values of 0.905 and 0.886, respectively. The deep learning-based causal inference model demonstrated an average 7.7% increase in the probability of CKRT occurrence when administrating vancomycin in total data set. Additionally, that younger age, lower diastolic blood pressure, higher heart rate, higher baseline creatinine, and lower bicarbonate levels sensitized the probability of CKRT application in response to vancomycin treatment. Deep learning-based causal inference models showed that vancomycin administration increases CKRT risk, identifying specific patient characteristics associated with higher susceptibility.IMPORTANCEThis study assesses the impact of vancomycin on the risk of continuous kidney replacement therapy (CKRT) in intensive care unit (ICU) patients with blood culture-positive infections. Utilizing deep learning-based causal inference and machine learning models, the research quantifies how vancomycin administration increases CKRT risk by an average of 7.7%. Key variables influencing susceptibility include baseline creatinine, diastolic blood pressure, heart rate, and bicarbonate levels. These findings offer insights into managing vancomycin-induced kidney risk and may inform patient-specific treatment strategies in ICU settings.

Synergistic Doping Strategy with Novel Multi-Carbonyl Conductive Polymer Enables Stable Self-Powered Perovskite Photodetectors.

Lead halide perovskites hold immense promise for optoelectronic applications but still suffer from instability caused by defects. The defects are mainly generated from the film fabrication processes and halide ion migration during long-term storage. Here, a synergistic doping strategy is proposed to enhance the stability of perovskites. A novel multi-carbonyl conductive polymer, poly(benzodifurandione) (PBFDO), is incorporated into the precursor solution to effectively passivate the unoccupied Pb2+ defects in perovskite films and promote the continuous growth of perovskites. An organic iodide, thiophene-2-ethylammonium iodide (TEAI), is doped in the transport layer to inhibit the halide ion migration and enhance the stability of perovskites synergistically. Self-powered photodetectors are constructed with improved stability, maintaining ≈90% of their initial photocurrents after being stored for ≈87 days in a humid atmosphere with 60% relative humidity. The optimized photodetectors show a high detectivity of 8.1×1012 Jones at 680 nm wavelength, wide linear dynamic range of 121.9 dB, and fast response with a rise/fall time of 1.92/1.17µs. A reflection-mode perovskite photoplethysmography testing system is developed, achieving high heart rate testing capabilities. This work suggests the great potential of perovskite photodetectors for noninvasive medical monitoring applications.

Clinical characteristics and diagnostic accuracy of preliminary diagnoses in adults with infections in Danish emergency departments: a multicentre combined cross-sectional and diagnostic study

ObjectiveRapid and accurate infection diagnosis is a prerequisite for appropriate antibiotic prescriptions in an ED. Accurately diagnosing acute infections can be difficult due to nonspecific symptoms and limitations of diagnostic...

Integrating structured and unstructured data for predicting emergency severity: an association and predictive study using transformer-based natural language processing models

BackgroundEfficient triage in emergency departments (EDs) is critical for timely and appropriate care. Traditional triage systems primarily rely on structured data, but the increasing availability of unstructured data, such as clinical notes, presents an opportunity to enhance predictive models for assessing emergency severity and to explore associations between patient characteristics and severity outcomes. This study aimed to evaluate the effectiveness of combining structured and unstructured data to predict emergency severity more accurately.MethodsData from the 2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) for adult ED patients were used. Emergency severity was categorized into urgent (scores 1–3) and non-urgent (scores 4–5) based on the Emergency Severity Index. Unstructured data, including chief complaints and reasons for visit, were processed using a Bidirectional Encoder Representations from Transformers (BERT) model. Structured data included patient demographics and clinical information. Four machine learning models—Logistic Regression, Random Forest, Gradient Boosting, and Extreme Gradient Boosting—were applied to three data configurations: structured data only, unstructured data only, and combined data. A mean probability model was also created by averaging the predicted probabilities from the structured and unstructured models.ResultsThe study included 8,716 adult patients, of whom 74.6% were classified as urgent. Association analysis revealed significant predictors of emergency severity, including older age (OR = 2.13 for patients 65 +), higher heart rate (OR = 1.56 for heart rates > 90 bpm), and specific chronic conditions such as chronic kidney disease (OR = 2.28) and coronary artery disease (OR = 2.55). Gradient Boosting with combined data demonstrated the highest performance, achieving an area under the curve (AUC) of 0.789, an accuracy of 0.726, and a precision of 0.892. The mean probability model also showed improvements over structured-only models.ConclusionsCombining structured and unstructured data improved the prediction of emergency severity in ED patients, highlighting the potential for enhanced triage systems. Integrating text data into predictive models can provide more accurate and nuanced severity assessments, improving resource allocation and patient outcomes. Further research should focus on real-time application and validation in diverse clinical settings.

Respiratory sinus arrhythmia in humans: Correlation analysis with breathing-specific heart rate

In adult humans at rest, pulmonary ventilation and cardiac output share similar values, both approximately 5 L/min. Airflow is intermittent, with tidal volumes exceeding dead space, low breathing frequency (fresp), and zero air velocity at both end-inspiration and end-expiration. In contrast, the cardiac pump is in series with the vasculature, such that the small stroke volume and high heart rate (HR) (fh) allow for quasi-continuous blood flow. Based on experimental findings in dogs, it has been suggested that an elevated fh during inspiration (known as respiratory sinus arrhythmia [RSA]) decreases the disparity between air and blood flow patterns. Thus, one might hypothesize a positive correlation between the peak-trough difference of instantaneous fh (&amp;Delta;HR&amp;rsquo; = HR&amp;rsquo;peak &amp;ndash; HR&amp;rsquo;trough) and the breathing-specific fh (fh/fresp). To test this hypothesis, we combined breath-by-breath data for &amp;Delta;HR&amp;rsquo; from several previous studies, resulting in a database of over 600 subjects. This extensive dataset allowed us to construct statistically meaningful correlations between &amp;Delta;HR&amp;rsquo; and variables associated with RSA (fh, fresp, HR&amp;rsquo;peak, and HR&amp;rsquo;trough). A strong statistically significant (r &gt; 0.9) correlation between fh/fresp and &amp;Delta;HR&amp;rsquo; was observed. These findings support the hypothesis that RSA may be a mechanism for improving the match between the quasi-continuous blood flow and the intermittent airflow.

Stress Reactivity, Wellbeing and Functioning in University Students: A Role for Autonomic Activity During Sleep.

Sleep is a key biological mechanism in promoting wellbeing and resilience to stress. This cross-sectional study examined connections between sleep, autonomic function, wellbeing, and stress reactivity in healthy individuals. Demographic, lifestyle, sleep, and psychological well-being information were collected from 85 healthy university students. These variables were analysed in conjunction with indices of cardiac autonomic activity, including heart rate and high frequency heart rate variability (HF HRV, an indicator of parasympathetic vagal tone) recorded during nocturnal sleep onset and in response to a cognitive stressor. Correlational analyses revealed that unrefreshing and fragmented sleep was strongly associated with lower HF HRV at sleep onset, suggestive of poorer autonomic de-arousal. Further, those with minimal increases in HF HRV from wakefulness to sleep reported worse sleep quality and greater challenges in daily activities compared to those with significant increases. This same group also demonstrated significantly greater reactivity and slower recovery when faced with a stressor the next day, as evidenced by comparison of heart rate values. Our findings suggest an association between autonomic hypervigilance and aspects of sleep quality, with potential implications for wellbeing and stress responses.

Comparative study risk factors of cardiovascular disease among subjects with arterial hypertension in the population of the Ryazan region (study ESSE of the Russian Federation 2)

Aim. To study the prevalence of risk factors (RFs) such as dyslipidemia, impaired glucose metabolism, high heart rate (HR), obesity, smoking, stress, anxiety, and depression among patients with a confirmed diagnosis of hypertension (HTN) and individuals with elevated office blood pressure (BP) but without a diagnosis of HTN.Material and methods. In the Ryazan region, as part of the state assignment of the Ministry of Health of the Russian Federation (the 2nd study under the ESSE program – “Epidemiology of cardiovascular diseases and their risk factors in the regions of the Russian Federation”), 1,632 people were examined, of whom those whose blood pressure did not fall below 140/90 mm Hg when measured twice were selected, (713 individuals). They were divided into 2 groups. Group A consisted of patients with a confirmed diagnosis of HTN, taking at least one antihypertensive medication (467 individuals, 62.7 % women, the median age was 52.0 years), and Group B consisted of individuals with elevated office BP but without a confirmed diagnosis of HTN and not taking antihypertensive medications (246 individuals, 41.1 % women, the median age was 44.0 years). A comparative assessment of RFs was conducted among them.Results. A high prevalence of dyslipidemia was observed in the groups without statistical difference between them at 86.1 and 83.4 %, respectively (p &gt; 0.05). However, frequency of impaired glucose metabolism was higher in patients of Groups A than that of Group B – 40.7 and 36.5 %, respectively (p = 0.004). The median body mass index (BMI) in Group A was 30.1 (26.8–33.4) kg/m2 , which was statistically significantly higher than the median in Group B, 29.3 (25.9–32.4) kg/m2 (p = 0.013). In Groups A and B, 13.9 and 16.6 % of individuals had normal BMI, 34.7 and 41.5 % had overweight, and 51.4 and 41.9 % had obesity, respectively, with no statistically significant difference between the groups in these measures. The smoking frequency was lower in Group A than in Group B, at 20.8 and 37.4 %, respectively (p &lt; 0.001). The median HR in Group A was 73.0 (67.0–79.5) bpm and it was statistically significantly lower as compared with that of Group B –76.0 (70.0–82.0) bpm (p &lt; 0.001), while the median of stress level (14.0 and 13.0 arbitrary units, p = 0.008), anxiety levels (6.0 and 4.5 arbitrary units, p &lt; 0.001), and depression levels (5.0 and 4.0 arbitrary units, p &lt; 0.001) were significantly higher in patients with HTN.Conclusion. A high prevalence of dyslipidemia, excess body weight/obesity, and impaired glucose metabolism was found in both groups. However, in Group A as compared with with Group B, statistically significantly higher levels of fasting glucose, HBa1c, BMI, stress, anxiety, and depression were observed, as well as a lower frequency of smoking and increased HR. The higher smoking frequency among women and the lower prevalence of anxiety and depression in the Ryazan Region population with HTN as compared with nationwide studies may indicate regional characteristics of these RFs.

Prevention of New-Onset Heart Failure in Atrial Fibrillation: The Role of Pharmacological Management.

Atrial fibrillation (AF) is the most common type of chronic arrythmia, with a lifetime prevalence of one in every three to five individuals above the age of 45 years. The higher heart rate, abnormal rhythm and inflammation caused by AF lead to changes in the function and structure of the heart. This, over time, can culminate in heart failure. In patients with AF, the lifetime prevalence of new-onset heart failure is twice that of stroke. The development of new-onset heart failure in AF is associated with high mortality. Despite the emphasis that AF guidelines put on preventing cardiovascular comorbidities, there is limited evidence regarding pharmacological therapies to prevent incident heart failure in individuals with AF. Specifically, the association between the use of rate control agents and incident heart failure in this population is unknown. Whilst rhythm control may reduce the risk of heart failure, the comparative effect of each pharmacological agent is not clear. In select subgroups of patients with AF, the choice of direct-acting oral anticoagulants and their optimal dosing has been attributed to a lower risk of new-onset heart failure. Future research is needed to identify an evidence-based approach to minimizing the development of heart failure in patients with AF.

Physiological response to exercise in the heat: Implications for risk mitigation and adaptation

ABSTRACT Purpose Recentfield studies of physical exertion in challenging environmentalconditions have reported dissociation between elevation in body coretemperature (Tc)and successful task completion. This prompted us to further examinephysiological mechanisms that might underlie variability in theresponse to exertional heat exposure. We hypothesized that, inresponse to exercise in the heat, systematic differences in centraland peripheral physiological variables would be apparent betweenparticipants who successfully completed the task, versus those whobecame hyperthermic or symptomatic. Methods 38healthy participants attempted a 120-min walk (5 km/h, 2%grade) in aclimate-controlled chamber (40⸰C,50%RH). At rest and at regular intervals during the walk, measures ofphysiological heat strain were assessed. Twenty-seven participantswere Completers, seven were stopped because their Tcexceeded 39⸰C(Hyperthermics), and four became Symptomatic (e.g. lightheaded,headache, dizzy)and did not complete the walk. Results Visceraladipose tissue was higher in those who became Hyperthermic, comparedto the Completers (437 ± 183vs 245 ± 268 g; p = 0.034),despite similar height and body mass. Hyperthermics also had higherheart rate (p = 0.009),and lower end-diastolic volume (p = 0.031),and stroke volume (p = 0.031)during the early stages of walking, compared to the Completers. Noneof theSymptomatics reached a Tc >39⸰C(symptoms occurred at 38.1 ± 0.4⸰C),and none of the Hyperthermics reported symptoms. Conclusions Duringexertional heat exposure, adiposity and exaggerated early-stagehemodynamic responses were related to Tcelevation, but hyperthermia was not related to the development ofsymptoms, and baseline parameters relating to body composition andfitness were not related to symptom development.

Pupil size correlates with heart rate, skin conductance, pulse wave amplitude, and respiration responses during emotional conflict and valence processing.

Pupil size is a non-invasive index for autonomic arousal mediated by the locus coeruleus-norepinephrine (LC-NE) system. While pupil size and its derivative (velocity) are increasingly used as indicators of arousal, limited research has investigated the relationships between pupil size and other well-known autonomic responses. Here, we simultaneously recorded pupillometry, heart rate, skin conductance, pulse wave amplitude, and respiration signals during an emotional face-word Stroop task, in which task-evoked (phasic) pupil dilation correlates with LC-NE responsivity. We hypothesized that emotional conflict and valence would affect pupil and other autonomic responses, and trial-by-trial correlations between pupil and other autonomic responses would be observed during both tonic and phasic epochs. Larger pupil dilations, higher pupil size derivative, and lower heart rates were observed in the incongruent condition compared to the congruent condition. Additionally, following incongruent trials, the congruency effect was reduced, and arousal levels indexed by previous-trial pupil dilation were correlated with subsequent reaction times. Furthermore, linear mixed models revealed that larger pupil dilations correlated with higher heart rates, higher skin conductance responses, higher respiration amplitudes, and lower pulse wave amplitudes on a trial-by-trial basis. Similar effects were seen between positive and negative valence conditions. Moreover, tonic pupil size before stimulus presentation significantly correlated with all other tonic autonomic responses, whereas tonic pupil size derivative correlated with heart rates and skin conductance responses. These results demonstrate a trial-by-trial relationship between pupil dynamics and other autonomic responses, highlighting pupil size as an effective real-time index for autonomic arousal during emotional conflict and valence processing.

Abstract 4136776: Prognostic Value of Resting Heart Rate and Heart Rate Variability in the 12-lead Electrocardiogram: Mortality Data From the CODE Nationwide Database

Introduction: Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network. Methods: We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively. Results: At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p&lt;0.001 and lower HRV: 84 (IQR 51-127) vs. 114 (IQR 74-153), p&lt;0.001. After adjustments (model 4), all HR quartiles were independently associated a progressively increased risk of all-cause mortality, being 88% higher for the 4 th quartile (HR=1.88 (95%CI 1.77–1.89). Similarly, the 1 st and 2 nd HRV quartiles remained associated with increased all-cause mortality (1 st quartile HR=1.42 (95%CI 1.37–1.47) in the final model. For cardiovascular mortality, HR was also an independent predictor, with a progressively higher risk, with a 77% increase (HR=1.77 95%CI 1.65–1.91) in the 4 th quartile. HRV was also an independent predictor of cardiovascular death, with a 33% risk increase (HR=1.33, 95%CI 1.23–1.44) for the 1 st quartile. Male gender, age, and all risk factors and comorbidities were also independent predictors of all-cause and cardiovascular mortality. Conclusions: In a large cohort of Brazilian adults, baseline HR and HRV were independent predictors of all-cause and cardiovascular mortality, after adjustment for clinical variables and autonomic indexes.

Abstract 4134249: Cardiovascular Risk Factors and Associations of Chronic Inflammatory-Related Disease in the Multi-Ethnic Study of Atherosclerosis

Background: Inflammation plays a role in the development of cardiovascular disease (CVD). We have defined various non-cardiovascular and non-cancer conditions, both infectious and non-infectious, with a common basis of inflammation; collectively termed Chronic Inflammatory-Related Disease (ChrIRD). We have previously described that ChrIRD is common, associated with baseline inflammatory marker levels, associated with high mortality, and has a bidirectional association with CVD. The clinical implications of these data require further study. Aims: We hypothesize that many traditional risk factors for CVD are also associated with ChrIRD and that ChrIRD has additional unique risk factors. We also hypothesize that the treatment of traditional CVD risk factors is associated with a decreased likelihood of ChrIRD. Methods: We studied MESA participants free of overt CVD or significant illness at baseline. ChrIRD was determined based on review of ICD codes for hospitalizations and deaths. Incident CVD was adjudicated by review of medical records. We performed proportional hazards regression (time-dependent for CVD) to identify factors associated with a first diagnosis of ChrIRD. All variables were simultaneously entered into the model. Results: Participants (n=6155) had mean age 62±10 years and 47% male gender. ChrIRD was observed in 24% and CVD in 18%; including 8% with both conditions. Participants with a diagnosis of CVD, older age, higher heart rate, higher BMI, current or ever smoking status, higher HDL, higher baseline IL6 and GlycA levels, and NSAID use had increased likelihood of ChrIRD. Whereas those with female sex, higher total cholesterol, and statin use had a decreased likelihood of ChrIRD. Participant race/ethnicity, blood pressure, diabetes status, antihypertensive use, aspirin use, baseline CRP level, and baseline D-dimer level were not associated with ChrIRD. Regression results are summarized in Table 1. Conclusions: ChrIRD shares some risk factors with CVD, while other risk factors are opposite. Better understanding of ChrIRD could eventually lead to improved patient care.

Myocardial Strain Assessment for Early Duchenne Muscular Dystrophy Diagnosis in Pediatric Patients Using Cardiac MRI

Assessing myocardial strain remains challenging, particularly in the pediatric population, due to the smaller heart sizes, higher heart rates, and variability in strain parameters compared to adult populations. This study aimed to investigate the utility of myocardial strain measurements using cardiac magnetic resonance-feature tracking (CMR-FT) for early diagnosis of Duchenne muscular dystrophy (DMD) in pediatric patients. Twenty-eight DMD patients and 20 healthy controls were involved in this study. Global circumferential, longitudinal, and radial strain (GCS, GLS, and GRS) were measured for the left ventricle (LV) using CMR-FT. Segmental strain values only of the inferolateral and anterolateral LV segments in DMD patients without late gadolinium enhancement (LGE) and DMD patients with LGE were compared to the healthy controls. Strain measurements using CMR-FT in DMD patients were considerably lower than those of healthy controls, with all p-values lower than 0.001. DMD patients without LGE showed decreased inferolateral and anterolateral segmental values only relative to healthy controls. The same behavior was maintained for the LV geometry. Multivariable linear regression demonstrated that the end-systole (ES) wall thicknesses and thickening were associated with decreased GCS and GLS. CMR-FT is crucial in detecting cardiac abnormalities in patients with DMD. It represents an innovative imaging biomarker that can detect initial myocardial alterations in DMD cardiomyopathy without relying on gadolinium.

Efficacy and safety of remimazolam tosilate in anesthesia for short otolaryngology surgery

BackgroundRemimazolam tosilate represents the novel ultrashort-acting benzodiazepine drug. This work focused on exploring whether remimazolam tosilate was effective and safe in anesthesia for short otolaryngology surgery in adults, and optimize its medication regimen, thus providing a theoretical basis for its widespread clinical application.MethodsThe present unicentric, double-blind, randomized controlled study enrolled altogether 85 otolaryngology surgery patients aged 18–60 years, and they were divided as remimazolam (RM, 42 cases) or midazolam (MD, 43 cases) group. Efficacy outcomes included successful sedation time, sedation effect (Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) score), bispectral index values (BIS), and postoperative recovery. The safety outcomes were patient vital signs at each time point (before induction (T0), 2 min and 5 min after trial drug treatment (T1 and T2 separately), during successful intubation (T3), at the end of surgery (T4), during extubation (T5), and at the time of exiting the room (T6)), any adverse reactions (AEs) during perioperative period, and patient satisfaction with anesthesia experience.ResultsDemographics were not significantly different in both groups (P > 0.05). RM group had significantly decreased successful sedation time relative to MD group (P < 0.05), while increased successful sedation rate (100%) relative to MD group (90.70%, P = 0.116). RM group showed decreased MOAA/S score and BIS value compared with MD group at T1 and T2 (P < 0.05). The spontaneous respiration recovery time and extubation time were not significantly different in both groups (P > 0.05), but RM group exhibited decreased discharge time compared with MD group (P < 0.05). Compared with MD group, the RM group had lower blood pressure (BP) at T3 (P < 0.05); whereas higher heart rate (HR) and respiration rate (RR) at T1 and T2 (P < 0.05). Difference in AEs was not of statistical significance. Finally, RM group exhibited the increased satisfaction of anesthesia experience compared with MD group (P < 0.05).ConclusionRemimazolam tosilate is effective on anesthesia for short otolaryngology surgery. Remimazolam shows the rapid onset, stable circulation, fast postoperative recovery, no increase in perioperative AEs, and high satisfaction with anesthesia experience compared with midazolam.Trial Registrationhttps://www.chictr.org.cn/ (ChiCTR2200067123) on 27/12/2022. This study was consistent with CONSORT guidelines.

The Correlation between Preoperative Average Heart Rate and Postoperative Recurrence in Patients with Paroxysmal Atrial Fibrillation Undergoing Transcatheter Radiofrequency Ablation.

Atrial fibrillation (AF) is the most common persistent arrhythmia, with increasing incidence worldwide. Transcatheter radiofrequency ablation (RFA) represents a first-line therapy for paroxysmal atrial fibrillation (PAF), although the long-term recurrence rate of AF remains relatively high. This study aimed to investigate the relationship between the average heart rate (AHR) on a dynamic electrocardiogram before transcatheter RFA and the postoperative recurrence of AF in patients with PAF. A retrospective analysis was conducted on patients with PAF who experienced primary transcatheter RFA. Relevant clinical indicators, dynamic electrocardiograms, and echocardiography were collected from the enrolled patients before ablation. Multivariate logistic regression analysis examined the relationship between the preoperative AHR and postoperative recurrence of AF in patients with PAF. This study included 224 patients with PAF who were scheduled for transcatheter RFA. Based on the AHR in sinus rhythm state on the dynamic electrocardiogram before ablation, the patients were divided into three groups: low, medium, and high heart rate. The recurrence rates of AF after ablation for the three groups were 14.667%, 8.108%, and 4.000%, respectively. After adjusting for confounding factors, postoperative AF recurrence risk gradually decreased with an increase in preoperative AHR (odds ratio: 0.849, 95% confidence interval: 0.729-0.988, p = 0.035). This trend remained statistically significant even after adjusting for the three categorical variables of AHR (odds ratio = 0.025, 95% confidence interval: 0.001-0.742, p = 0.033). The curve fitting analysis indicated a linear and negative correlation between the preoperative AHR and postoperative AF recurrence risk in patients with PAF. In patients with PAF who experienced their primary transcatheter RFA, there was a linear and negative correlation between the AHR in sinus rhythm state on the preoperative dynamic electrocardiogram and the risk of postoperative AF recurrence.

Comparison of Remimazolam and Propofol for Intravenous Anesthesia on Trigeminocardiac Reflex in Percutaneous Balloon Compression for Trigeminal Neuralgia: A Randomized Controlled Trial.

Trigeminal neuralgia usually presents as incapacitating facial pain. Percutaneous balloon compression (PBC) is frequently utilized to manage this ailment. Trigeminocardiac reflex (TCR) commonly presents with sudden severe bradycardia or even asystole, alongside a sudden increase in blood pressure during this surgical procedure. Notably, remimazolam has been reported to maintain higher heart rate (HR) levels during anesthesia than propofol. Thus, this study aims to assess the impact of remimazolam anesthesia versus propofol on TCR occurrence during this procedure. This randomized controlled trial involved patients with trigeminal neuralgia scheduled for elective PBC. Patients were randomly assigned to receive either remimazolam or propofol for anesthesia. The primary outcome was the incidence of TCR, a potential complication during the procedure. Secondary outcomes included the occurrence of severe TCR, usage of atropine, HR at the time of foramen ovale puncture (T4), HR at the time of trigeminal ganglion compression (T5), and any adverse events. A total of 80 patients were included in the study, with 40 patients in each group. The incidence of TCR was significantly lower in the remimazolam group compared to the propofol group (30.0% vs 82.5%; risk difference -52.5%, 95% CI -67.3% to -18.6%; P < 0.001). The remimazolam group also showed a lower incidence of severe TCR (7.5% vs 45.0%) and significantly lower usage of atropine compared to the propofol group (P < 0.001). Furthermore, HR at T4 and T5 were higher in the remimazolam than in the propofol group (P < 0.001). There was no significant difference in the incidence of adverse events between the two groups. In PBC surgery for trigeminal neuralgia, remimazolam-based intravenous anesthesia showed a higher HR and a lower incidence of TCR than propofol without any increased adverse events.

Predicting blood pressure response to renal denervation based on a new approach.

Identifying predictors of blood pressure (BP) response to renal denervation (RDN) is crucial for patient selection. According to Wilder's principle, baseline BP predicts BP change after any antihypertensive intervention. Thus, any observed BP change after RDN is the sum of the BP change depending on the baseline BP and the specific BP reduction due to RDN. Based on this concept, we propose a new definition of BP responders. In our center, 148 patients with uncontrolled hypertension underwent RDN, and 24-h ambulatory BP (ABP) was measured at baseline, and 6 months after the procedure. The decrease in 24-h systolic BP (SBP) correlated with baseline SBP (P = <0.001, r = -0.374). We determined the RDN-specific effect by subtracting the predicted SBP decrease from the observed SBP decrease. The cohort was divided into RDN responders, neutral responders, and nonresponders. Our study population had a mean age of 59 ± 10.4 years and was 74% male. The RDN-specific (residual) 24-h ABP decreased by -14.9 ± 6.3/-8.2 ± 3.8 mmHg (responder group), 1.0 ± 3.2/0.2 ± 1.9 mmHg (neutral group), and 14.2 ± 10.4/8.3 ± 3.9 mmHg (nonresponder group) 6 months after RDN. Responders had fewer antihypertensive medications (P = 0.018), higher baseline office heart rate (HR) (P = 0.019), higher 24-h ambulatory HR (P = 0.003), lower BMI (P < 0.038), and absence of type 2 diabetes (T2D) (P = 0.020). Our definition of BP responders to RDN separates baseline BP-related changes from RDN-specific changes. Positive predictors for BP response to RDN include low BMI, fewer antihypertensive medications, high baseline office HR, high 24-h ambulatory HR, and absence of T2D.

A Review of Factors Affecting Radiation Dose and Image Quality in Coronary CTA Performed with Wide-Detector CT.

Compared with traditional invasive coronary angiography (ICA), coronary CT angiography (CCTA) has the advantages of being rapid, economical, and minimally invasive. The wide-detector CT, with its superior temporal resolution and robust three-dimensional reconstruction technology, thus enables CCTA in patients with high heart rates and arrhythmias, leading to a high potential for clinical application. This paper systematically summarizes wide-detector CT hardware configurations of various vendors routinely used for CCTA examinations and reviews the effects of patient heart rate and heart rate variability, scanning modality, reconstruction algorithms, tube voltage, and scanning field of view on image quality and radiation dose. In addition, novel technologies in the field of CT applied to CCTA examinations are also presented. Since this examination has a diagnostic accuracy that is highly consistent with ICA, it can be further used as a routine examination tool for coronary artery disease in clinical practice.