RESUMEN
Atrial Fibrillation (AF) is an important cardiac rhythm disorder, which if left untreated can lead to serious complications such as a stroke. AF can remain asymptomatic, and it can progressively worsen over time; it is thus a disorder that would benefit from detection and continuous monitoring with a wearable sensor. We develop an AF detection algorithm, deploy it on a smartwatch, and prospectively and comprehensively validate its performance on a real-world population that included patients diagnosed with AF. The algorithm showed a sensitivity of 87.8% and a specificity of 97.4% over every 5-minute segment of PPG evaluated. Furthermore, we introduce novel algorithm blocks and system designs to increase the time of coverage and monitor for AF even during periods of motion noise and other artifacts that would be encountered in daily-living scenarios. An average of 67.8% of the entire duration the patients wore the smartwatch produced a valid decision. Finally, we present the ability of our algorithm to function throughout the day and estimate the AF burden, a first-of-this-kind measure using a wearable sensor, showing 98% correlation with the ground truth and an average error of 6.2%.
Asunto(s)
Fibrilación Atrial , Dispositivos Electrónicos Vestibles , Fibrilación Atrial/diagnóstico , Electrocardiografía , Humanos , Monitoreo Fisiológico , FotopletismografíaRESUMEN
Dysregulated IL-1ß and IL-6 responses have been implicated in the pathogenesis of severe Coronavirus Disease 2019 (COVID-19). Innovative approaches for evaluating the biological activity of these cytokines in vivo are urgently needed to complement clinical trials of therapeutic targeting of IL-1ß and IL-6 in COVID-19. We show that the expression of IL-1ß or IL-6 inducible transcriptional signatures (modules) reflects the bioactivity of these cytokines in immunopathology modelled by juvenile idiopathic arthritis (JIA) and rheumatoid arthritis. In COVID-19, elevated expression of IL-1ß and IL-6 response modules, but not the cytokine transcripts themselves, is a feature of infection in the nasopharynx and blood but is not associated with severity of COVID-19 disease, length of stay, or mortality. We propose that IL-1ß and IL-6 transcriptional response modules provide a dynamic readout of functional cytokine activity in vivo, aiding quantification of the biological effects of immunomodulatory therapies in COVID-19.
RESUMEN
Understanding the pathophysiology of SARS-CoV-2 infection is critical for therapeutic and public health strategies. Viral-host interactions can guide discovery of disease regulators, and protein structure function analysis points to several immune pathways, including complement and coagulation, as targets of coronaviruses. To determine whether conditions associated with dysregulated complement or coagulation systems impact disease, we performed a retrospective observational study and found that history of macular degeneration (a proxy for complement-activation disorders) and history of coagulation disorders (thrombocytopenia, thrombosis and hemorrhage) are risk factors for SARS-CoV-2-associated morbidity and mortality-effects that are independent of age, sex or history of smoking. Transcriptional profiling of nasopharyngeal swabs demonstrated that in addition to type-I interferon and interleukin-6-dependent inflammatory responses, infection results in robust engagement of the complement and coagulation pathways. Finally, in a candidate-driven genetic association study of severe SARS-CoV-2 disease, we identified putative complement and coagulation-associated loci including missense, eQTL and sQTL variants of critical complement and coagulation regulators. In addition to providing evidence that complement function modulates SARS-CoV-2 infection outcome, the data point to putative transcriptional genetic markers of susceptibility. The results highlight the value of using a multimodal analytical approach to reveal determinants and predictors of immunity, susceptibility and clinical outcome associated with infection.