1,721,189 research outputs found
Exercise Dynamics in Secondary Mitral Regurgitation Pathophysiology and Therapeutic Implications
No full textSecondary mitral valve regurgitation (MR) remains a challenging problem in the diagnostic workup and treatment of patients with heart failure. Although secondary MR is characteristically dynamic in nature and sensitive to changes in ventricular geometry and loading, current therapy is mainly focused on resting conditions. An exercise-induced increase in secondary MR, however, is associated with impaired exercise capacity and increased mortality. In an era where a multitude of percutaneous solutions are emerging for the treatment of patients with heart failure, it becomes important to address the dynamic component of secondary MR during exercise as well. A critical reappraisal of the underlying disease mechanisms, in particular the dynamic component during exercise, is of timely importance. This review summarizes the pathophysiological mechanisms involved in the dynamic deterioration of secondary MR during exercise, its functional and prognostic impact, and the way current treatment options affect the dynamic lesion and exercise hemodynamics in general.This work was funded, in part, by Research Foundation-Flanders grant 11N7214N (P.B.B.), National Institutes of Health grant R01 HL109506 (R.A.L.), and Leducq Foundation grant 07CVD04
Is cardiac telerehabilitation cost-efficient in the longterm? The Telerehab III 2-year follow-up study
No full textPublication published at doi: 10.1080/00015385.2017.128436
Atrial Functional Mitral Regurgitation: Definition, Mechanisms, and Treatment Perspectives
No full textPurpose of ReviewThis review aims to explore the complex interplay between atrial functional mitral regurgitation (AFMR), atrial fibrillation (AF), and heart failure with preserved ejection fraction (HFpEF). The goal is to define these conditions, examine their underlying mechanisms, and discuss treatment perspectives, particularly addressing diagnostic challenges.Recent FindingsRecent research highlights the rising prevalence of AFMR, now accounting for nearly one-third of significant mitral regurgitation cases. Advances in percutaneous treatment options have improved management for vulnerable HFpEF patients, but long-term outcomes remain unclear, and symptom relief is inconsistent.SummaryAF and HFpEF share the left atrium as a common pathological substrate, with progressive LA remodeling contributing to AFMR. Diagnostic limitations hinder effective symptom management with current mitral valve interventions. Future research should focus on better diagnostic tools to determine the contributions of valvular disease, arrhythmia, or myocardial dysfunction to clinical outcomes, as we currently lack definitive tests to establish this connection.Fund for Scientific Research Flanders [FWO 11PGA24N
Is cardiac telerehabilitation cost-efficient in the longterm? The Telerehab III 2-year follow-up study
No full textPublication published at doi: 10.1080/00015385.2017.128436
Intrathoracic fluid changes from preconception to postpartum as measured by bio-impedance monitoring
No full textIntrathoracic impedance was remotely monitored from preconception to postpartum in a woman with an implantable cardioverter defibrillator. At 6 and 20 weeks, two significant changes were recorded, suggestive for thoracic fluid accumulation. After normal outcome, postpartum intrathoracic impedance returned to preconception values. The obtained results from this case report show that these measurements can be obtained with an implanted device. Current devices for measuring cardiac output by impedance technique allow evaluating thoracic fluid changes non-invasively. As such, non-invasive impedance monitoring may be a potential new method for continuous monitoring of maternal vascular changes during any time window between preconception and postpartum, to be assessed in a large cross sectional observational study.This report is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. No specific funding was provided for publication of this case report.Lanssens, D (reprint author), Ziekenhuis Oost Limburg, Dept Gynaecol, Schiepse Bos 6, Genk, Belgium.
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The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction
No full textBackgroundMajor classes of medical therapy for heart failure with reduced ejection fraction (HFrEF) induce reverse remodeling. The revere remodeling response to sacubitril/valsartan remains unstudied. MethodsWe performed a single-center, prospective assessor-blinded study to determine the reverse remodeling response of sacubitril/valsartan therapy in HFrEF patients with a class I indication (New York heart Association [NYHA]-class II-IV, Left ventricular ejection fraction [LVEF] < 35%, optimal dose with Renin-Angiotensin-System-Blocker [RAS-blocker]). Doses of sacubitril/valsartan were optimized to individual tolerance. Echocardiographic images were assessed offline by 2 investigators blinded to both the clinical data and timing of echocardiograms. ResultsOne-hundred-twenty-five HFrEF patients (6610years) were prospectively included. The amount of RAS-blocker before and after switch to sacubitril/valsartan was similar(P=.290), indicating individual optimal dosing of sacubitril/valsartan. Over a median(IQR) follow-up of 118(77-160)days after initiation of sacubitril/valsartan, LVEF improved (29.6 +/- 6% vs 34.8 +/- 6%; P<.001) and Left ventricular end-systolic (LVESV) and end-diastolic volume (LVEDV) decreased (LVESV; 147 +/- 57mL vs 129 +/- 55mL; P<.001 and LVEDV; 206 +/- 71mL vs197 +/- 72mL; P=.027). Volumetric remodeling was associated with a reduction in the degree of mitral regurgitation (1.59 +/- 1.0 vs 1.11 +/- 0.8; P<.001; [scale from 0-4]). Metrics of diastolic function improved; including a drop in the E/A-wave ratio (1.75 +/- 1.13 vs 1.38 +/- 0.88; P=.002) and diastolic filling time (% of cycle length) prolonged (48 +/- 9% vs 52 +/- 1%; P=.005). The percent of patients with a restrictive mitral filling pattern dropped from 47% to 23% (P=.004). A dose-dependent effect was noted for changes in LVEF (P<.001) and LVESV (P=.031), with higher doses of sacubitril/valsartan leading to more reverse remodeling. ConclusionSwitching therapy in eligible HFrEF patients from a RAS-blocker to sacubitril/valsartan induces beneficial reverse remodeling of both metrics of systolic as diastolic function.Pieter Martens is supported by a doctoral fellowship by the Research Foundation - Flanders (FWO, grant-number: 1127917N). Pieter Martens, Pieter Vandervoort and Wilfried Mullens are researchers for the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital
Validation of a smartphone based photoplethysmographic beat detection algorithm for normal and ectopic complexes
No full textBackground: To date little or no smartphone apps exist to differentiate between a normal heart beat and a premature ectopic beat. Aim: To develop and validate a smartphone based acquisition and processing algorithm based on photopletyhsmographic (PPG) data collected in a controlled hospital environment. Methods: A smartphone camera application was developed to record PPG data in synchronization with a reference electrocardiogram. Subjects were recorded while undergoing an electrophysiological examination. The PPG data acquisition was validated on 28 volunteers with sinus rhythm. After signal analysis an algorithm was developed for detection of ectopic beats. To characterize arrhythmias, supraventricular extrasystoles were induced every 10, 5 or 3 beats after 500 ms by applying a pacing train to the right atrium. The coupling interval was also examined by altering the intermediary time by 400, 500 or 600 ms. Results: After signal conditioning, an accurate ectopic beat detection was obtained from the PPG signal. Premature atrial ectopic beats could be differentiated based on the interpeak distance at different coupling intervals. Conclusion: By acquiring a PPG signal with the camera, the smartphone is not only capable of determining a regular sinus rhythm, but it also has the power to identify ectopic beats
Detection of subclinical transient fluid accumulation during pregnancy in a patient with an implantable cardioverter defibrillator and OptiVol (R) fluid monitoring algorithm
No full textValidation of a smartphone based photoplethysmographic beat detection algorithm for normal and ectopic complexes
No full textBackground: To date little or no smartphone apps exist to differentiate between a normal heart beat and a premature ectopic beat. Aim: To develop and validate a smartphone based acquisition and processing algorithm based on photopletyhsmographic (PPG) data collected in a controlled hospital environment. Methods: A smartphone camera application was developed to record PPG data in synchronization with a reference electrocardiogram. Subjects were recorded while undergoing an electrophysiological examination. The PPG data acquisition was validated on 28 volunteers with sinus rhythm. After signal analysis an algorithm was developed for detection of ectopic beats. To characterize arrhythmias, supraventricular extrasystoles were induced every 10, 5 or 3 beats after 500 ms by applying a pacing train to the right atrium. The coupling interval was also examined by altering the intermediary time by 400, 500 or 600 ms. Results: After signal conditioning, an accurate ectopic beat detection was obtained from the PPG signal. Premature atrial ectopic beats could be differentiated based on the interpeak distance at different coupling intervals. Conclusion: By acquiring a PPG signal with the camera, the smartphone is not only capable of determining a regular sinus rhythm, but it also has the power to identify ectopic beats
Remote Monitoring of COVID-19 Patients Following Discharge from a Tertiary Care Center
No full textThe COVID-19 pandemic has affected people, healthcare systems and caregivers on a global scale causing bottlenecks in hospital resources and overload of healthcare systems. The presence of disease sequelae in
patients hospitalized due to COVID-19 warrants additional care and monitoring of these patients. Remote monitoring techniques have been implemented in several domains of healthcare such as cardiology, cardiac rehabilitation and nephrology. Monitoring of vital signs using these technologies has allowed the tracking of patients with more granularity, resulting in better clinical outcomes such as reduction in hospitalizations. Therefore, we hypothesize that remote monitoring is beneficial in managing COVID-19 patients post-hospitalization, enabling home-based patient follow-up. In this study, we investigated the use of remote
monitoring on a COVID-19 patient cohort discharged from a tertiary care center. A post-hoc division of patients into two groups (alert-generating patients and non-alert generating patients) was performed. The longitudinal progression of sensor and questionnaire data was studied using linear mixed-effect models. The measured heart rate values were statistically significant in terms of the intercept (p<0.001), indicating a difference between the two patient groups at baseline immediately post-discharge.The authors would like to acknowledge Dr. David Ruttens for his help in data collection for this project. The authors would like to thank the assistants and nurses at the Department of Pneumology, Ziekenhuis Oost-Limburg as well as the scientific researchers of Future Health for their help in the data collection procedure
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