Anomalies électrocardiographiques chez les patients hospitalisés pour COVID-19 à Fianarantsoa, Madagascar

Les anomalies électrocardiographiques sont l'expression d'une atteinte cardiovasculaire lors de la COVID-19. Les troubles du rythme et de la conduction cardiaque peuvent mettre en jeu le pronostic vital à court terme au cours de la COVID -19. Notre objectif principal est de décrire les anomalies électrocardiographiques et leurs fréquences chez les patients atteints de la COVID -19. L'objectif secondaire est de déterminer l'association entre ces anomalies électrocardiographiques et la gravité de la maladie. Méthodes : Il s'agit d'une étude rétrospective à visée descriptive des patients hospitalisés pour COVID-19 dans les centres de traitement COVID -19 de Fianarantsoa sur une période de 14 mois. Résultats : Nous avons retenu 101 patients. Le sex-ratio était de 1,06. La moyenne d'âge était de 59,81ans +/- 11,9. Tous les patients retenus avaient un électrocardiogramme à 12 dérivations et un test positif à la COVID-19. L'électrocardiogramme (ECG) était anormal chez 87 (86,1%) patients. Dans les formes graves et modérées de la maladie nous avons enregistré à l'ECG: 51 (50,5%) tachycardies sinusales, 13 (12,8%) blocs de branche incomplets droits, 13 (12,8%) profil S1Q3T3, 24 (23,7%) ondes Q pathologiques, 19 (18,8%) anomalies du segment ST. Dans les formes graves de la maladie nous avons enregistré à l'ECG: 2 (3,8%) bloc auriculoventriculaire complet (BAV complet), 7 (13,4%) blocs de branche gauche complet (BBG), 5 (9,6%) blocs de branche droit complet (BBD). La tachycardie sinusale avait une association significative avec la gravité de la maladie (p=0,002). Conclusion : Des anomalies électrocardiographiques ont été observées dans notre étude. La tachycardie sinusale était associée à la gravité de la maladie. Une surveillance rythmique, des explorations cardiaques plus pertinentes sont nécessaires pour une meilleure prise charge de la COVID-19

Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study

Abstract BACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.

Autonomic dysfunction is common in liver cirrhosis and is associated with cardiac dysfunction and mortality: prospective observational study

ABSTRACT BACKGROUND: Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis. OBJECTIVE: To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality. DESIGN AND SETTING: Prospective observational study conducted in the Federal University of São Paulo. METHOD: A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters. RESULTS: The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100. CONCLUSION: Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.

Left atrial function analysis in patients with functional mitral regurgitation associated with dilated cardiomyopathy / Análise da função atrial esquerda em pacientes com insuficiência mitral funcional associada à miocardiopatia dilatada

BACKGROUND: Functional mitral regurgitation (FMR) is associated with dilated cardiomyopathy (DC), heart failure (HF), and worsening left atrial function (LAF). Patients with DC and FMR may present left atrial dysfunction resulting from both ventricular dysfunction and valve disease, but it is unknown whether the presence of valve disease will lead to greater LAF impairment. OBJECTIVE: This study aimed to evaluate the relationship between LAF parameters and FMR degree in patients with DC. METHODS: This cross-sectional observational study included 214 patients with DC, 46 without FMR (control group) and 168 with mild, moderate or severe FMR. An LAF analysis was performed by speckle tracking echocardiography (STE) and atrial volumetric variation. RESULTS: LAF analyzed by STE by means of reservoir strain, conduit strain and active contraction strain was reduced in the sample, with values of 14.3%, 8.49% and 5.92%, respectively. FMR degree was significantly associated with reservoir strain (0.27 ± 0.16 versus 0.15 ± 0.09; p < 0.001) and contraction strain (19.2 ± 7.3 versus 11.2 ± 2.7; p < 0.001). FMR was also associated with a reduced LAF assessed by volumetric analysis: total atrial emptying fraction of 0.51 ± 0.13 versus 0.34 ± 0.11 and active atrial emptying fraction of 0 .27 ± 0.16 versus 0.15 ± 0.09 (p < 0.001). CONCLUSION: In a population with DC, FMR was associated with reduced LAF assessed by STE and atrial volume variation.

FUNDAMENTO: A insuficiência mitral funcional (IMF) está associada à miocardiopatia dilatada (MD), à insuficiência cardíaca (IC) e à piora da função atrial esquerda (FAE). A FAE pode decair tanto pela disfunção ventricular quanto pela valvopatia, mas não se sabe se esta leva a um prejuízo maior da FAE. OBJETIVO: Avaliar a relação entre a piora de parâmetros de FAE com o grau de IMF, em pacientes com MD. MÉTODOS: Trata-se de estudo observacional transversal, que incluiu 214 pacientes com MD, sendo 46 sem IMF (controle) e 168 com IMF discreta, moderada ou grave. A análise da FAE foi realizada por ecocardiografia por speckle tracking (STE) e por variação volumétrica atrial. RESULTADOS: A FAE, analisada por STE­ por meio do strain de reservatório, conduto e contração ativa ­ encontrou-se reduzida na amostra, com valores respectivos de 14,3%, 8,49% e 5,92%. O grau de IMF associou-se significativamente com os valores do strain de reservatório (0,27±0,16 versus 0,15±0,09; p <0,001. CONCLUSÃO: Em uma população com MD, a presença de IMF associa-se à redução da FAE de reservatório e de contração, avaliada por STE e pela variação volumétrica atrial.

Acompanhamento a longo prazo de paciente do sexo masculino com fibroma cardíaco assintomático / Long-Term follow-up of an asymptomatic man with a cardiac fibroma

Descreve-se o caso de um homem de 19 anos assintomático com fibroma de ventrículo esquerdo em acompanhamento por 15 anos, sem tratamento.(AU)

Here we describe a case of a 19-year-old asymptomatic man with a left ventricular fibroma on follow-up for 15 years with no treatment required.(AU)

Aplicación de una ley matemática exponencial a la dinámica cardíaca en 16 horas: estudio realizado con 250 pacientes / Application of an exponential mathematical law to cardiac dynamics in 16 hours: a study of 250 patients

Resumen Introducción: Los sistemas dinámicos y la geometría fractal han sido el sustrato para el advenimiento de una ley matemática aplicada al diagnóstico de la dinámica cardíaca en 21 horas. Objetivo: Confirmar la aplicabilidad clínica de la ley matemática exponencial en 16 horas a partir de un estudio de concordancia diagnóstica frente a la norma de referencia. Materiales y método: Se realizó un estudio con 250 registros electrocardiográficos continuos y ambulatorios; 50 pertenecían a pacientes normales y 200 a pacientes con diversas enfermedades cardíacas. Se simuló la secuencia de frecuencias cardíacas y se construyeron los atractores correspondientes. Se calculó la dimensión fractal y la ocupación del atractor en el espacio generalizado de box-counting. Por último, se estableció el diagnóstico fisicomatemático en 16 y 21 horas y se efectuó la validación estadística. Resultados: Los espacios de ocupación para normalidad en la rejilla pequeña se encontraron entre 205 y 372, y entre 56 y 201 para dinámicas patológicas, lo cual permitió evidenciar la capacidad del método para diferenciar normalidad de enfermedad a través de la ocupación espacial de los atractores con base en la ley matemática en 16 horas. Se hallaron valores de sensibilidad y especificidad del 100% y un coeficiente kappa del orden de 1, luego de comparar el diagnóstico fisicomatemático frente a la norma de referencia. Conclusión: La ley matemática exponencial en 16 horas demostró su utilidad como herramienta de ayuda diagnóstica y predictiva, lo cual permitió diferenciar normalidad y estados evolutivos hacia enfermedad y agudización.

Abstract Introduction: Dynamic systems and fractal geometry have been the substrate for the rising of a mathematical law applied to the diagnosis of cardiac dynamics in 21 hours. Objective: To confirm the clinical applicability of the exponential mathematical law in 16 hours, with a study of diagnostic agreement against the Gold Standard. Materials and method: It was made a study with 250 ambulatory and continuous electrocardiographic recordings, 50 belonged to normal patients and 200 to patients with various cardiac pathologies. The sequence of heart rates was simulated, and attractors were constructed. It was calculated the fractal dimension of the attractor and its occupation in the generalized Box-Counting space. Finally, it was determined the physical-mathematical diagnostic in 16 and 21 hours, and statistical validation was performed. Results: The occupation spaces in the small grid were between 205 and 372 for normality, and between 56 and 201 for pathologic dynamics, which demonstrated the ability of the method to differentiate normal condition from sickness, through spatial occupation of attractors according to mathematical law in 16 hours. There were obtained values of sensitivity and specificity of 100% and Kappa coefficient was 1, after comparing the physic-mathematical analysis against the Gold Standard. Conclusion: The exponential mathematical law in 16 hours proved its utility as diagnostic and predictive tool support, allowing to differentiate normal, developmental stages to disease and exacerbation.

Alterações eletrocardiográficas em pacientes com Leishmaniose Tegumentar Americana tratados com antimoniato de meglumina: revisão integrativa / Electrocardiographic changes in patients with American tegumentary leishmaniasis treated with meglumine antimoniate: integrative review

Introdução: a Leishmaniose Tegumentar Americana (LTA) é uma infecção zoonótica cujo tratamento é realizado com a droga antimoniato de meglumina (AM). Objetivo: Relatar as alterações eletrocardiográficas decorrentes do uso de AM em pacientes com LTA. Metodologia: foi realizada uma revisão integrativa da literatura por meio das bases de dados BIREME, PUBMED, COCHRANE, SCIELO e literatura cinzenta, usando como estratégia de busca o cruzamento dos seguintes descritores, nos idiomas português e inglês: leishmaniose cutânea, eletrocardiografia, meglumina e toxicidade. Não foi estipulado um intervalo temporal para que um maior número de publicações fosse obtido. Resultados: foram encontrados 134 artigos, desses apenas 09 atenderam aos critérios de inclusão. As principais alterações eletrocardiográficas encontradas durante a terapêutica foram as alterações de repolarização ventricular, com destaque para o prolongamento do intervalo QT corrigido pela frequência cardíaca. Já entre as alterações mais graves em termos de morbimortalidade, destacam-se as arritmias ventriculares complexas, principalmente a Torsade de pointes. Discussão: em todos os artigos selecionados foram encontradas alterações ao eletrocardiograma (ECG) durante o tratamento com AM, sendo recomendado em todos os pacientes, o acompanhamento eletrocardiográfico. Apenas um estudo excluiu as alterações do ECG basal, presença de comorbidades e uso de drogas cardiotóxicas sendo esses possíveis vieses para avaliação da toxicidade cardíaca diretamente provocada pelo antimonial. Conclusão: considerando as alterações na repolarização ventricular e as possíveis arritmias ventriculares em pacientes em tratamento para LTA em uso de AM, o acompanhamento eletrocardiográfico é recomendado durante a terapêutica de todos esses pacientes, sendo útil para prevenção de complicações cardiovasculares importantes.

Introduction: American Tegumentary Leishmaniasis (ATL) is a zoonotic infection whose treatment is carried out with the meglumine antimoniate drug (AM). Objective: To report the electrocardiographic changes resulting from the use of AM in patients with ATL. Methodology: an integrative literature review was carried out using the BIREME, PUBMED, COCHRANE, SCIELO and gray literature databases, using as a search strategy the crossing of the following descriptors, in Portuguese and English: cutaneous leishmaniasis, electrocardiography, meglumine and toxicity. A time interval was not stipulated in order to obtain a greater number of publications. Results: we found 134 articles, of which only 9 met the inclusion criteria. The main electrocardiographic changes found during therapy were changes in ventricular repolarization, with emphasis on the prolongation of the QT interval corrected by heart rate. Already the most serious changes in terms of morbidity and mortality, complex ventricular arrhythmias, especially Torsade de pointes, stand out. Discussion: changes in the electrocardiogram (ECG) were found in all selected articles during treatment with AM, with electrocardiographic monitoring being recommended in all patients. Only one study excluded: changes in the baseline ECG, the presence of comorbidities and / or use of cardiotoxic drugs, these being possible biases to assess cardiac toxicity directly caused by the antimonial. Conclusion: considering the changes in ventricular repolarization and possible ventricular arrhythmias in patients undergoing treatment for ATL using AM, electrocardiographic monitoring is recommended during the therapy of all these patients, being useful for the prevention of important cardiovascular complications.

Confirmación diagnóstica de la metodología diseñada para evaluar los registros Holter durante 18 horas mediante la entropía proporcional / Diagnostic confirmation of the methodology designed to evaluate the Holter registers for 18 hours through proportional entropy

Resumen Introducción: Los sistemas dinámicos, la entropía y la probabilidad han contribuido de forma significativa al desarrollo de nuevas metodologías que caracterizan al grado de complejidad de la dinámica cardíaca. Objetivo: Confirmar la aplicabilidad clínica de la metodología fundamentada en la teoría de los sistemas dinámicos, la probabilidad y la entropía para evaluar la dinámica cardíaca durante 18 horas. Material y métodos: Se tomaron 570 registros Holter normales en diferentes enfermedades. Para cada uno se construyó un atractor en un mapa de retardo y se evaluó la probabilidad de ocupación de pares ordenados de frecuencias cardíacas durante 18 horas, así como la entropía y sus proporciones. Se compararon las medidas obtenidas con los valores de normalidad y enfermedad establecidos previamente para obtener el diagnóstico matemático de cada Holter. Las conclusiones del Holter se revelaron luego de aplicar la metodología fisicomatemática para calcular sensibilidad, especificidad y coeficiente kappa respecto de la norma de referencia clínica. Resultados: Con las proporciones de la entropía de los atractores se diferenciaron dinámicas cardíacas agudas, crónicas, normales y la evolución entre estos estados con resultados de sensibilidad y especificidad del 100% con una concordancia entre la norma de referencia y el diagnóstico fisicomatemático evaluado con el coeficiente kappa de 1. Conclusiones: Este estudio confirma que la metodología aplicada logra diagnosticar objetivamente la dinámica cardíaca, ya que establece predicciones de estados de normalidad o del nivel de agravamiento de la dinámica, y evidencia la aplicabilidad de esta metodología, lo cual sugiere su potencial uso en el contexto clínico.

Abstract Introduction: Dynamic systems, entropy and probability have contributed significantly in the development of new methodologies that characterize the degree of complexity of cardiac dynamics. Objective: To confirm the clinical applicability of the methodology based on the theory of dynamic systems, probability and entropy to evaluate cardiac dynamics during 18 hours. Material and methods: 570 normal Holter records with different pathologies were taken. For each one an attractor was built on the delay map and the probability of occupation of ordered pairs of heart rates during 18 hours was evaluated, as well as the entropy and its proportions. The measurements obtained were compared with the values of normality and illness established previously to obtain the mathematical diagnosis of each Holter. The conclusions of the Holter were unblinded after having applied the physical-mathematical methodology to calculate sensitivity, specificity and Kappa coefficient with respect to the Gold-Standard. Results: With the proportions of the entropy of the attractors, acute, chronic, normal, and evolution cardiac dynamics were differentiated between these states. the application of the methodology showed a sensitivity and specificity of 100 %. The agreement between the Gold-Standard and the physical-mathematical diagnosis evaluated with the kappa coefficient was 1. Conclusions: This study confirms that the applied methodology manages to objectively diagnose cardiac dynamics, establishing predictions of normality states or the level of aggravation of the dynamics, evidencing the applicability of this methodology, suggesting its potential use in the clinical context.

Electrocardiografía en chequeo médico precompetitivo: subanálisis de un registro unicéntrico prospectivo / Electrocardiography in pre-competitive medical fit: Subanalysis of a prospective single-center registry

Resumen Introducción: La interpretación del electrocardiograma del deportista muchas veces se ve complicada por los cambios producidos por el entrenamiento prolongado. Objetivos: Comparar la aplicación de los criterios de Seattle para valoración electrocardiográfica en deportistas en un grupo de cardiólogos del instituto de Cardiología y medicina del deporte, contra un profesional especializado en electrocardiografía del deportista, bajo los mismos criterios. Material y métodos: Sobre una base de datos prospectiva de pacientes que concurrieron al centro de medicina del deporte entre junio de 2017 y enero de 2018 para realización de apto físico, se incluyeron para el análisis 499 electrocardiogramas. Siete cardiólogos del Instituto de deportes (IW) valoraron los electrocardiogramas como "normales"; "alteraciones normales" o "alteraciones dudosas o anormales" (que requirieron más estudios en el seguimiento) conociendo los antecedentes del paciente al igual que los estudios realizados y la valoración cruzada de los electrocardiogramas dentro del instituto. Un cardiólogo del cuerpo médico de Boca Juniors especializado en electrocardiografía del deportista (FR) valoró los 499 electrocardiogramas de manera ciega (sin conocer los datos demográficos de los pacientes o los antecedentes patológicos) utilizando los mismos criterios. Resultados: De un total de 499 electrocardiogramas, 448 (89%) fueron interpretados como normales por el especialista en electrocardiografía del deporte vs. 459 (91%) por los cardiólogos del instituto de deporte. Respecto a alteraciones normales, 21 (4%) electrocardiogramas fueron considerados como alteraciones normales para el especialista en electrocardiografía vs. 23 (4%) por el instituto de deportes. 30 (6%) electrocardiogramas presentaron alteraciones dudosas o anormales para el especialista vs. 17 (3%) para el instituto de deporte. Conclusiones: La interpretación electrocardiográfica puede presentar variaciones de un centro a otro a pesar de utilizar criterios estandarizados. Es probable que la evaluación clínica influencie los resultados.

Abstract Introduction: The interpretation of the athlete's electrocardiogram is often complicated by the changes produced by prolonged training. Objective: To compare the application of Seattle criteria for electrocardiographic assessment in a group of cardiologists against a professional specialized in electrocardiography of the athlete under the same criteria. Material and methods: On a prospective database of recreational athletes who attended between June 2017 and January 2018 to perform physical fitness, 499 electrocardiograms were included for the analysis. Seven cardiologists from the Sports Institute (IW) rated the electrocardiograms as "normal"; "Normal alterations" or "dubious or abnormal alterations" knowing the patient's background as well as the studies performed. A cardiologist from the Boca Juniors medical team specialized in sportsman's electrocardiography (RF) assessed the 499 electrocardiograms blindly (without knowing the demographic data of the patients or the pathological background) using the same criteria. Results: Out of a total of 499 electrocardiograms, 448 (89%) were interpreted as normal by the sports electrocardiography specialist vs 459 (91%) by the cardiologists of the sports institute. Regarding normal alterations, 21 (4%) electrocardiograms were considered normal alterations for the electrocardiography specialist vs 23 (4%) by the sports institute. 30 (6%) electrocardiograms showed doubtful or abnormal alterations for the specialist vs 17 (3%) for the sports institute. Conclusions: The electrocardiographic interpretation can present variations from one center to another despite using standardized criteria. It is likely that the clinical evaluation.

Physical training in athletes: analysis of cardiac autonomic modulation / Treinamento físico em esportistas: análise da modulação autonômica cardíaca / Entrenamiento físico en deportistas: análisis de la modulación autonómica cardíaca

ABSTRACT Introduction Cardiac autonomic modulation (CAM) is a result of the balance between the sympathetic and parasympathetic systems. This interaction results in heart rate variation (HRV), analyzed by specific electrocardiographic parameters. These parameters are modified by the practice of physical activity, indicating better cardiac conditioning. Objectives To evaluate the cardiac autonomic modulation of athletes of the XXVIII Ecological Walk at two separate times during their period of physical training. Also, to link the practice of physical activity with stress reduction in these individuals. Methods 24-hour Holter exams were performed at two times (before and after a 2-month period of non-standard physical training), and the results were analyzed using the software programs Epi-Info 7 and BioEstat 5.0. Inferential analysis was performed by the nonparametric Shapiro-Wilk test. Statistical significance was assigned to p values less than 0.05, with 95% confidence interval (95% CI). Results The sample was mostly male (n = 14; 77.78%), with a mean age of 49.55 years. No individual trained for less than 60 days; most (47.06%) trained for 151-200 days, with walking being the predominant modality (64.71%). No statistically significant difference was found in the parameters HRV pNN50 (p = 0.18), rMSSD (p = 0.14) or HF (p = 0.117) after the evaluated training period. Conclusions Participants who are longtime sportsmen and physically active showed parasympathetic saturation, therefore, they did not show significant changes in HRV. Also, low levels of stress were observed in those who practiced physical activity. Level of evidence II; Prognosis Study.

RESUMO Introdução A modulação autonômica cardíaca (MO) é resultado do equilíbrio entre os sistemas simpático e parassimpático. Essa interação resulta na variação da frequência cardíaca (VFC) analisada por parâmetros eletrocardiográficos específicos, que são modificados pela prática de atividade física, indicando melhor condicionamento cardíaco. Objetivos Analisar a modulação autonômica cardíaca em esportistas da XXVIII Caminhada Ecológica em dois momentos durante seu período de treinamento físico. Além disso, relacionar a prática de atividade física com a redução do estresse nesses indivíduos. Métodos Foram realizados exames de Holter de 24 horas em dois momentos (antes e depois de um período de dois meses de treinamento físico não padronizado), sendo os resultados analisados por meio dos programas Epi-Info 7 e BioEstat 5.0. A análise inferencial foi feita pelo teste não paramétrico de Shapiro-Wilk. A significância estatística foi atribuída aos valores de p menores que 0,05 e intervalo de confiança de 95% (IC 95%). Resultados A amostra era majoritariamente masculina (n = 14; 77,78%), com média de idade de 49,55 anos. Nenhum indivíduo treinou por menos de 60 dias, a maioria (47,06%) treinou por 151 a 200 dias, sendo a caminhada a modalidade predominante (64,71%). Não foi encontrada diferença estatisticamente significativa nos parâmetros de VFC pNN50 (p = 0,18), rMSSD (p = 0,14) e HF (p = 0,117) depois do período de treinamento avaliado. Conclusão Os participantes que são esportistas de longa data e fisicamente ativos apresentaram saturação parassimpática, por isso não evidenciaram alterações significativas na VFC. Além disso, observou-se menor nível de estresse nos praticantes de atividade física. Nível de evidência II; Estudo prognóstico.

RESUMEN Introducción La modulación autonómica cardíaca (MO) es el resultado del equilibrio entre los sistemas simpático y parasimpático. Esta interacción resulta en la variación de la frecuencia cardíaca (VFC), analizada por parámetros electrocardiográficos específicos, que son modificados por la práctica de actividad física, indicando mejor acondicionamiento cardíaco. Objetivos Analizar la modulación autonómica cardíaca en deportistas de la XXVIII Caminata Ecológica en dos momentos durante su período de entrenamiento físico. Además, relacionar la práctica de actividad física con la reducción del estrés en estos individuos. Métodos Fueron realizados exámenes Holter de 24 horas en dos momentos (antes y después de un período de dos meses de entrenamiento físico no estandarizado), siendo los resultados analizados por medio de los programas Epi-Info 7 y BioEstat 5.0. El análisis inferencial se realizó mediante el test no paramétrico de Shapiro-Wilk. La significancia estadística fue atribuida a los valores de p inferiores a 0,05 e intervalo de confianza del 95% (IC 95%). Resultados La muestra era mayoritariamente masculina (n = 14; 77,78%), con un promedio de edad de 49,55 años. Ningún individuo entrenó durante menos de 60 días, la mayoría (47,06%) entrenó durante 151-200 días, siendo la caminata la modalidad predominante (64,71%). No fue encontrada diferencia estadísticamente significativa en los parámetros de VFC pNN50 (p = 0,18), rMSSD (p = 0,14) y HF (p = 0,117) después del período de entrenamiento evaluado. Conclusión Los participantes que son deportistas de larga data y físicamente activos presentaron saturación parasimpática, por eso no evidenciaron alteraciones significativas en la VFC. Además, se observó un menor nivel de estrés en los practicantes de actividad física. Nivel de evidencia II; Estudio pronóstico.

Cardiomiopatia arritmogênica do ventrículo direito em maratonista: relato de caso / Arrhythmogenic right ventricular cardiomyopathy in marathon runners: case report

A cardiomiopatia arritmogênica do ventrículo direito é uma desordem hereditária caracterizada pela substituição fibrogordurosa do músculo cardíaco. O manejo clínico busca reduzir os riscos de morte súbita e melhorar a qualidade de vida, aliviando os sintomas arrítmicos e de insuficiência cardíaca. O ecocardiograma é o exame inicial para a investigação da cardiomiopatia arritmogênica do ventrículo direito, podendo apresentar dilatação das câmaras direitas e disfunção sistólica do ventrículo direito. Este relato chama atenção por envolver o diagnóstico de cardiomiopatia arritmogênica do ventrículo direito em paciente atleta. Mulher, 47 anos, maratonista, sem história familiar de morte súbita cardíaca, deu entrada na emergência com palpitação associada à pré-síncope. O eletrocardiograma da admissão mostrava taquicardia ventricular. O ecocardiograma revelou aumento de câmaras cardíacas direitas e disfunção sistólica do ventrículo direito. O cateterismo cardíaco não evidenciou doença coronária obstrutiva. A paciente foi orientada acerca da necessidade de suspensão de atividades físicas, porém, 3 meses depois, foi readmitida com instabilidade hemodinâmica por nova taquicardia ventricular, tendo sido cardiovertida. Realizou ressonância cardíaca, que evidenciou áreas de discinesia e formação de microaneurismas em ventrículo direito. Foi diagnosticada com cardiomiopatia arritmogênica do ventrículo direito, tendo sido com cardioversor desfibrilador implantável, amiodarona e betabloqueador. A diferenciação entre a cardiomiopatia arritmogênica do ventrículo direito e o coração do atleta representa um desafio, devido à sobreposição de alterações estruturais que coexistem nessas entidades, daí a importância da análise integrada de fatores clínicos, eletrocardiográficos e morfofuncionais.(AU)

Síndrome de ALCAPA em uma Mulher Jovem / ALCAPA Syndrome in a Young Woman

Mulher de 18 anos com histórico de síncope, angina e palpitações há um ano. Uma indicação crucial era artéria coronária direita dilatada na ecocardiografia transtorácica. Os achados da tomografia computadorizada resultaram no diagnóstico da origem anômala da artéria coronariana esquerda proveniente da síndrome da artéria pulmonar.(AU)

Automatic Detection System of ECG Performance Based on Single Channel ECG Recorder / 中国医疗器械杂志

Aiming at the ECG performance indicators in the YY 0885-2013 "Medical electrical equipment Part 2: Particular requirements for the safety including essential performance of ambulatory electrocardiographic systems", the traditional detection methods are time-consuming and the test results are greatly affected by human factors. In this paper, an automated detection method is proposed. A set of automatic detection software for ECG performance is designed and developed based on a single-channel ECG recorder, and an automated detection system is set up in combination with standard testing equipment. And then, the MSA tool is used to analyze the repeatability and stability of the detection system, and the results show that the detection system is acceptable, and it can improve detection efficiency.

Study on the quality evaluation of electrocardiogram signal in wearable physiological monitoring system / 生物医学工程学杂志

As a novel technology, wearable physiological parameter monitoring technology represents the future of monitoring technology. However, there are still many problems in the application of this kind of technology. In this paper, a pilot study was conducted to evaluate the quality of electrocardiogram (ECG) signals of the wearable physiological monitoring system (SensEcho-5B). Firstly, an evaluation algorithm of ECG signal quality was developed based on template matching method, which was used for automatic and quantitative evaluation of ECG signals. The algorithm performance was tested on a randomly selected 100 h dataset of ECG signals from 100 subjects (15 healthy subjects and 85 patients with cardiovascular diseases). On this basis, 24-hour ECG data of 30 subjects (7 healthy subjects and 23 patients with cardiovascular diseases) were collected synchronously by SensEcho-5B and ECG Holter. The evaluation algorithm was used to evaluate the quality of ECG signals recorded synchronously by the two systems. Algorithm validation results: sensitivity was 100%, specificity was 99.51%, and accuracy was 99.99%. Results of controlled test of 30 subjects: the median (Q1, Q3) of ECG signal detected by SensEcho-5B with poor signal quality time was 8.93 (0.84, 32.53) minutes, and the median (Q1, Q3) of ECG signal detected by Holter with poor signal quality time was 14.75 (4.39, 35.98) minutes (Rank sum test,

Aplicación de la ley de Zipf-Mandelbrot al diagnóstico de la dinámica cardíaca normal y aguda / Application of the law of Zipf-Mandelbrot to the diagnosis of normal and acute cardiac dynamics

Introducción: Es conocida la capacidad de los fractales estadísticos en la evaluación de la complejidad de diferentes sistemas cuya dinámica pueda ser evaluada a partir de las frecuencias de una variable; para esto, se utiliza la medida de la dimensión fractal estadística, la cual puede ser calculada con la ley de Zipf-Mandelbrot. Esta ley matemática ha sido aplicada en cardiología para evaluar el grado de complejidad de la dinámica cardíaca. En el presente trabajo se aplicó la ley de Zipf-Mandelbrot junto con la metodología diagnóstica desarrollada previamente para evaluar dinámicas cardíacas normales y con enfermedad aguda. Materiales y métodos: Se tomaron 15 registros Holter; 10 con diagnóstico normal y 5 con patologías agudas de pacientes de la Unidad de Cuidados Intensivos. Se organizaron jerárquicamente las frecuencias de aparición de las frecuencias cardíacas de cada dinámica en rangos de a 15 lat/min, en busca del comportamiento hiperbólico necesario para la aplicación de la ley de Zipf-Mandelbrot. Posteriormente se realizó una linealización y se obtuvo la dimensión fractal estadística para cada dinámica. Resultados: Los valores de la dimensión fractal estadística para una dinámica cardíaca aguda variaron entre 0.4925 y 0.6061, mientras que para una dinámica normal variaron entre 0.7134 y 0.9749, evidenciando la diferenciación entre ambos grupos. Conclusiones: El comportamiento fractal estadístico de la dinámica cardíaca fue corroborado, de igual forma la pérdida de complejidad para las dinámicas agudas respecto a las dinámicas normales

Background: The capacity of statistical fractals in the evaluation of the complexity of different systems whose dynamics can be evaluated from the frequencies of a variable is known. This is why the measure of the statistical fractal dimension is used, which can be calculated with the Zipf-Mandelbrot law, this mathematical law has been applied in cardiology evaluating the degree of complexity of cardiac dynamics. In the present work, the Zipf-Mandelbrot law was applied together with the diagnostic methodology previously developed to evaluate normal cardiac dynamics and acute disease. Material and methods: 15 Holter records were taken; 10 with normal diagnosis and 5 with acute pathologies of patients of the Intensive Care Unit. The frequencies of occurrence of the heart frequencies of each dynamics were organized hierarchically in ranges of 15 lat/min, in search of the hyperbolic behavior required for the application of the law of Zipf-Mandelbrot. Subsequently, a linearization was performed and the statistical fractal dimension was obtained for each dynamics. Results: The values of the statistical fractal dimension for acute cardiac dynamics varied between 0.4925 and 0.6061, whereas for normal dynamics they varied between 0.7134 and 0.9749, evidencing the differentiation between both groups. Conclusions: The statistical fractal behavior of the cardiac dynamics was corroborated, as well as the loss of complexity for the acute dynamics with respect to the normal dynamics

Evaluación de registros Holter durante 19 horas en el contexto de la teoría de la probabilidad / Evaluation of 19-hour Holter recordings in the context of probability theory

Resumen Introducción: Previamente se desarrolló una nueva metodología de ayuda diagnóstica para los registros Holter fundamentada en los sistemas dinámicos y la teoría de probabilidad, a partir de la información registrada en 21 horas. Objetivo: Evaluar la capacidad diagnóstica de esta metodología durante 19 horas, comparándola con los resultados convencionales del Holter y con los resultados del método matemático aplicado en 21 horas. Materiales y Métodos: fueron evaluados 80 casos de pacientes mayores a 20 años, 10 con registro Holter normal y 70 diagnosticados de forma convencional con diferentes patologías cardíacas. Se establecieron los rangos para las frecuencias cardíacas y de número de latidos por hora en 21 y 19 horas; luego, se calculó la probabilidad de ocurrencia de estos, lo que permitió diferenciar estados de normalidad y enfermedad aguda a partir de tres parámetros. Se comparó el diagnóstico físico-matemático con el diagnóstico convencional, tomado como Gold Standard. Resultados: De los casos normales, dos presentaron probabilidad menor o igual a 0,217 y ocho probabilidades mayores o igual a 0,304; ningún caso de enfermedad aguda presentó valores con probabilidad menor o igual a 0,217, mientras que todos presentaron valores mayores o iguales a 0,304, tanto para los registros Holter evaluados en 21 como en 19 horas. Conclusiones: Se confirmó la utilidad clínica de la metodología ante una reducción del tiempo de evaluación a 19 horas, obteniendo diagnósticos objetivos con base en la auto-organización matemática del fenómeno.

Abstract Background: a new method to help evaluate 21-hour holter recordings based on dynamic systems and the theory of probability was previously developed Aim: to evaluate the diagnostic value of this methodology in the analysis of 19 hr compared to conventional holter analysis over a 21-hr recording. Methods: the holter recordings of 80 subjects aged over 20 years old were analyzed. Ten subjects had a normal holter and 70 conventionally diagnosed as abnormal. Ranges for heart rate and number of beats in 21 or 19 hours were determined. The probability of their occurrence was calculated using 3 parameters. The mathematically derived diagnosis was compared to the clinical diagnosis, considered a gold standard. Results: Among normal cases the calculated probability was ≤ 0.217 in 2 cases and ≥0.304 in 8. No case with acute disease presented probability values ≤0.217; all had probability values ≥0.304, both in 21 and 19 hour recordings. Conclusion: the mathematical methodology described was clinically useful allowing a reduction in recording time from 21 to 19 hr. Clinical diagnosis may be inferred from the mathematical organization of a holter recording.

Association between blood pressure, inflammation and spirometry parameters in chronic obstructive pulmonary disease

BACKGROUND/AIMS: Many systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction. METHODS: We included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups. RESULTS: In COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV₁%). Diastolic blood pressure was associated with pH and HCO₃ levels. The mean night time, day time pulse pressures and 24-hour pulse per minute values were also associated with all the parameters except FEV₁%. CONCLUSIONS: In this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.

The study on extraction method of pulse rate variability in daily unsupervised state / 生物医学工程学杂志

The extraction of pulse rate variability(PRV) in daily life is often affected by exercise and blood perfusion. Therefore, this paper proposes a method of detecting pulse signal and extracting PRV in post-ear, which could improve the accuracy and stability of PRV in daily life. First, the post-ear pulse signal detection system suitable for daily use was developed, which can transmit data to an Android phone by Bluetooth for daily PRV extraction. Then, according to the state of daily life, nine experiments were designed under the situation of static, motion, chewing, and talking states, respectively. Based on the results of these experiments, synchronous data acquisition of the single-lead electrocardiogram (ECG) signal and the pulse signal collected by the commercial pulse sensor on the finger were compared with the post-auricular pulse signal. According to the results of signal wave, amplitude and frequency-amplitude characteristic, the post-ear pulse signal was significantly steady and had more information than finger pulse signal in the traditional way. The PRV extracted from post-ear pulse signal has high accuracy, and the accuracy of the nine experiments is higher than 98.000%. The method of PRV extraction from post-ear has the characteristics of high accuracy, good stability and easy use in daily life, which can provide new ideas and ways for accurate extraction of PRV under unsupervised conditions.

A Digital Filtering Method for Eliminating DC Offset in Ambulatory ECG Signals / 中国医疗器械杂志

The amplifier is easy to saturation because of polarization voltage in ambulatory ECG acquisition. The traditional way is using analog high-pass filter to eliminate, but the output tends to have a residue. If upgrading high-pass filter cutoff frequency, it will lead to low frequency distortion of ECG signals. In this paper, a Savitzky-Golay (SG) smoothing filter has been designed by combining the single edge point and the polynomial order , which can fit the polarization voltage components of ECG signals, filter useful components and get drift-free ECG signals by using the subtraction algorithm. The results of ECG filtering experiment verify the feasibility of the SG smoothing filter, and show the filtered ECG signal without any losses of useful components.