Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring?

Heart rate variability (HRV) is a measurement of the fluctuation of time between each heartbeat and reflects the function of the autonomic nervous system. HRV is an important indicator for both physical and mental status and for broad-scope diseases. In this review, we discuss how wearable devices can be used to monitor HRV, and we compare the HRV monitoring function among different devices. In addition, we have reviewed the recent progress in HRV tracking with wearable devices and its value in health monitoring and disease diagnosis. Although many challenges remain, we believe HRV tracking with wearable devices is a promising tool that can be used to improve personal health.

Radiation exposure during distal and traditional radial coronary angiography and percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

OBJECTIVES: Previous studies show that the distal transradial approach (dTRA) is safe and effective for coronary angiography and percutaneous coronary intervention. However, the effect of dTRA on radiation exposure in the catheterization laboratory has not been characterized. The authors analyzed the available literature to compare the radiation exposure associated with dTRA vs the traditional radial approach (TRA). METHODS: A systematic review and meta-analysis of the scientific literature was conducted by using relevant terms to search the PubMed, Embase, and Cochrane Library databases from their inception until October 13, 2022, to identify randomized controlled trials (RCTs) comparing dTRA with TRA. The primary outcome was radiation exposure reported as fluoroscopy time, air kerma, or kerma-dose product. The standard mean difference (SMD) and its 95% confidence interval were used to summarize continuous variables. Random effect and meta-regression also were used for analyses. RESULTS: Among 484 studies identified, 7 were RCTs, with a total of 3427 patients (1712 dTRA, 1715 TRA). No difference was found between dTRA and TRA in radiation exposure quantified as fluoroscopy time (SMD -0.10 [-0.36, 0.15], P=.43) or air kerma (SMD -0.31 [-0.74, 0.13], P=.17). The overall estimate favored lower kerma-area product in the TRA (SMD 0.19 [0.08, 0.30], P=.0006). Meta-regression showed no correlation between fluoroscopy time and year of publication. CONCLUSIONS: Compared with TRA, dTRA was associated with significantly greater radiation exposure per the kerma-area product during interventional cardiology procedures, with no differences in fluoroscopy time and air kerma.

Evaluation of large animal models for preclinical studies of heart failure with preserved ejection fraction using clinical score systems.

Heart failure with preserved ejection fraction (HFpEF) is characterized by a complex, heterogeneous spectrum of pathologic features combined with average left ventricular volume and diastolic dysfunction. HFpEF is a significant public health problem associated with high morbidity and mortality rates. Currently, effective treatments for HFpEF represent the greatest unmet need in cardiovascular medicine. A lack of an efficient preclinical model has hampered the development of new devices and medications for HFpEF. Because large animal models have similar physiologic traits as humans and appropriate organ sizes, they are the best option for limiting practical constraints. HFpEF is a highly integrated, multiorgan, systemic disorder requiring a multipronged investigative approach. Here, we review the large animal models of HFpEF reported to date and describe the methods that have been used to create HFpEF, including surgery-induced pressure overloading, medicine-induced pressure overloading, and diet-induced metabolic syndrome. In addition, for the first time to our knowledge, we use two established clinical HFpEF algorithms (HFA-PEFF and H2FPEF scores) to evaluate the currently available large animal models. We also discuss new technologies, such as continuous remote pressure monitors and inflatable aortic cuffs, as well as how the models could be improved. Based on current progress and our own experience, we believe an efficient large animal model of HFpEF should simultaneously encompass multiple pathophysiologic factors, along with multiorgan dysfunction. This could be fully evaluated through available methods (imaging, blood work). Although many models have been studied, only a few studies completely meet clinical score standards. Therefore, it is critical to address the deficiencies of each model and incorporate novel techniques to establish a more reliable model, which will help facilitate the understanding of HFpEF mechanisms and the development of a treatment.

Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily rouTine (EXPERT) Trial.

BACKGROUND: The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators. METHODS: Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol. RESULTS: Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38). CONCLUSION: TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.

Early Changes in Acute Myocardial Infarction in Pigs: Achieving Early Detection with Wearable Devices.

We examined the changes in variables that could be recorded on wearable devices during the early stages of acute myocardial infarction (AMI) in an animal model. Early diagnosis of AMI is important for prognosis; however, delayed diagnosis is common because of patient hesitation and lack of timely evaluations. Wearable devices are becoming increasingly sophisticated in the ability to track indicators. In this study, we retrospectively reviewed the changes in four variables during AMI in a pig model to assess their ability to help predict AMI onset. AMI was created in 33 pigs by 90-min balloon occlusion of the left anterior descending artery. Blood pressure, EKG, and lactate and cardiac troponin I levels were recorded during the occlusion period. Blood pressure declined significantly within 15 min after balloon inflation (mean arterial pressure, from 61 ± 8 to 50 ± 8 mmHg) and remained at this low level. Within 5 min of balloon inflation, the EKG showed ST-elevation in precordial leads V1-V3. Blood lactate levels increased gradually after occlusion and peaked at 60 min (from 1.48 to 2.53 mmol/L). The continuous transdermal troponin sensor demonstrated a gradual increase in troponin levels over time. Our data suggest that significant changes in key indicators (blood pressure, EKG leads V1-V3, and lactate and troponin levels) occurred at the onset of AMI. Monitoring of these variables could be used to develop an algorithm and alert patients early at the onset of AMI with the help of a wearable device.

Device-based therapy for decompensated heart failure: An updated review of devices in development based on the DRI2P2S classification.

Congestive heart failure (HF) is a devastating disease leading to prolonged hospitalization, high morbidity and mortality rates, and increased costs. Well-established treatments for decompensated or unstable patients include medications and mechanical cardiac support devices. For acute HF decompensation, new devices are being developed to help relieve symptoms and recover heart and renal function in these patients. A recent device-based classification scheme, collectively classified as DRI2P2S, has been proposed to better describe these new device-based therapies based on their mechanism: dilators (increase venous capacitance), removers (direct removal of sodium and water), inotropes (increase left ventricular contractility), interstitials (accelerate removal of lymph), pushers (increase renal arterial pressure), pullers (decrease renal venous pressure), and selective (selective intrarenal drug infusion). In this review, we describe the new class of medical devices with the most current results reported in preclinical models and clinical trials.

Using the Apple Watch to Record Multiple-Lead Electrocardiograms in Detecting Myocardial Infarction: Where Are We Now?

Although the outcome after myocardial infarction depends on the time to treatment, a delay between symptom onset and treatment is common. Apple Watch, a popular wearable device, provides the ability to perform an electrocardiogram. We review the progress made in using the Apple Watch to record multiple electrocardiogram leads for diagnosing myocardial infarction. Although the data are encouraging, many limitations remain, and more research is needed. Nevertheless, the Apple Watch could eventually serve as a self-check tool for patients who have chest pains or other symptoms of myocardial infarction, thus substantially decreasing the time to treatment and improving the outcome after myocardial infarction.

Segurança do paciente em hemodinâmica: trajetória de um serviço em busca da excelência / Patient safety in the cath lab: the trajectory of a service in search of excellence

Introdução: A segurança do paciente é considerada uma prioridade global pela Organização Mundial da Saúde, e o Brasil, como país-membro, lançou, em 2013, o Programa Nacional de Segurança do Paciente, recomendando práticas seguras para todos os serviços de saúde. Embora obrigatório, muitos estabelecimentos não possuem Núcleos de Segurança do Paciente estruturados para o gerenciamento de seus riscos e incidentes. Objetivo: Descrever a experiência na implantação de um programa de segurança para pacientes submetidos a procedimentos hemodinâmicos. Métodos: Estudo observacional, descritivo e retrospectivo da criação do Núcleo de Segurança do Paciente e do programa de gerenciamento de riscos. Resultados: O núcleo foi constituído em 2014, e o programa foi desenvolvido em quatro fases: criação do plano de segurança, mapeamento de riscos, criação de instruções de trabalho e gerenciamento de incidentes. Entre dezembro de 2014 e dezembro de 2019, foram monitorados 6.913 pacientes e identificado 146 incidentes, sendo 44,52% classificados como inconformidade a protocolos, 20,54% como circunstância notificável, 13,69% como quase-erro, 10,95% como incidente sem dano e 10,27% como evento adverso (incidente com dano). Entre 2017 e 2019, observaram-se redução no número de inconformidade de protocolo (0,66% versus 0,42%; p=0,01) e circunstância notificável (0,5% versus 0,32%; p=0,32), com incremento na comunicação de quase erro (0% versus 0,07%; p=0,018). Ao longo do estudo, observou-se aumento na adesão às metas dos indicadores relacionados à notificação de incidentes, ao tempo porta-balão e às horas- treinamento. Conclusão: A criação do Núcleos de Segurança do Paciente, somada à incorporação de um plano efetivo, é ferramenta efetiva, que contribui para a construção de uma cultura de excelência.

Background: Patient safety is considered a global priority by the World Health Organization, and Brazil, as a Member State, launched the National Patient Safety Program in 2013, recommending safe practices for all health services. Although mandatory, many facilities do not have structured Patient Safety Units to manage their risks and incidents. Objective: To describe the experience in implementing a safety program for patients undergoing invasive cardiology procedures. Methods: This was an observational, descriptive, and retrospective study on the creation of a patient safety unit and a risk management program. Results: The unit was established in 2014, and the program was developed in four phases: creation of the safety plan, risk mapping, creation of work instructions, and incident management. Between December 2014 and December 2019, a total of 6,913 patients were monitored and 146 incidents were identified, with 44.52% classified as non-compliance to protocol, 20.54% as reportable circumstances, 13.69% as near-misses, 10.95% as no harm incidents, and 10.27% as adverse events (harmful incidents). Between 2017 and 2019, there was a reduction in amount of non-compliance to protocol (0.66% versus 0.42%; p=0.01) and reportable circumstances (0.5% versus 0.32%; p=0.32), with an increase in near-miss reporting (0% versus 0.07%; p=0.018). Throughout the study, there was an increase in adherence to indicator targets related to incident reporting, door-to-balloon time, and training hours. Conclusion: The creation of Patient Safety Units, together with employing an effective plan, is an effective tool that contributes to the construction of a culture of excellence.

Dose-Tracking System as a Tool to Manage Radiation Exposure.

We describe the use of a radiation dose-tracking system (Canon Medical Systems) that can help physicians provide patients with better care after higher radiation exposure dose following lengthy procedures.

MQL Strategies Applied in Ti-6Al-4V Alloy Milling-Comparative Analysis between Experimental Design and Artificial Neural Networks.

This paper presents a study of the Ti-6Al-4V alloy milling under different lubrication conditions, using the minimum quantity lubrication approach. The chosen material is widely used in the industry due to its properties, although they present difficulties in terms of their machinability. A minimum quantity lubrication (MQL) prototype valve was built for this purpose, and machining followed a previously defined experimental design with three lubrication strategies. Speed, feed rate, and the depth of cut were considered as independent variables. As design-dependent variables, cutting forces, torque, and roughness were considered. The desirability optimization function was used in order to obtain the best input data indications, in order to minimize cutting and roughness efforts. Supervised artificial neural networks of the multilayer perceptron type were created and tested, and their responses were compared statistically to the results of the factorial design. It was noted that the variables that most influenced the machining-dependent variables were the feed rate and the depth of cut. A lower roughness value was achieved with MQL only with the use of cutting fluid with graphite. Statistical analysis demonstrated that artificial neural network and the experimental design predict similar results.

Angioplastia coronariana primária em pacientes com mais de 80 anos / Primary coronary angioplasty in patients over 80 years of age

Introdução: É cada vez mais prevalente o número de idosos submetidos à intervenção coronariana percutânea primária (ICPp). Historicamente, essa população apresenta pior prognóstico quando comparada aos mais jovens. Nosso objetivo foi comparar as características e os desfechos clínicos em 30 dias de pacientes ≥ 80 anos aos < 80 anos submetidos à ICPp. Métodos: Estudo de coorte observacional, prospectivo, extraído do banco de dados do Instituto de Cardiologia do Rio Grande do Sul, entre 2009 e 2013. Resultados: Foram incluídos 1.970 pacientes, sendo 122 (6,2%) com idade ≥ 80 anos. Os mais idosos mostraram predomínio do sexo feminino (50% vs. 29%; p < 0,001), diabetes (34,4% vs. 23,2%; p = 0,004), classe Killip 3 ou 4 (13,1% vs. 7,4%; p = 0,02) e tempo porta-balão superior (1,4 hora [1,0-1,9 hora] vs. 1,1 hora [0,8-1,5 hora]; p < 0,001). O fluxo TIMI 3 pós não mostrou diferença entre os grupos (86% vs. 90,7%; p = 0,08), mas o Blush 3 pós foi menor (59,3% vs. 70,9%; p = 0,01) nos idosos. O sucesso angiográfico foi obtido em 92,0% vs. 95,6%; p = 0,07. Necessidade de marca-passo provisório, arritmias graves e morte súbita abortada foram mais frequentes nos pacientes ≥ 80 anos. Taxas de eventos cardiovasculares adversos maiores e óbito em 30 dias foram mais frequentes no grupo mais idoso (32,2% vs. 11,5% e 29,7% vs. 7,2%; p < 0,001). Conclusões: Nesta análise contemporânea, pacientes ≥ 80 anos submetidos à ICPp apresentaram perfil clínico e angiográfico mais grave, tempo porta-balão mais prolongado, menor Blush 3 final, com maiores taxas de complicações hospitalares e mortalidade em 30 dias, quando comparados aos pacientes mais jovens

Background: The number of elderly patients submitted to primary percutaneous coronary intervention (PCI) is increasingly prevalent. Historically, this population has a worse prognosis when compared to the younger ones. This study aimed to compare the characteristics and 30-day clinical outcomes of patients aged ≥ 80 years to those < 80 years submitted to primary PCI. Methods: Observational, prospective cohort study, extracted from the database of Instituto de Cardiologia do Rio Grande do Sul, between 2009 and 2013. Results: A total of 1,970 patients were included, of whom 122 (6.2%) were aged ≥ 80 years. The elderly showed a predominance of the female gender (50% vs. 29%; p < 0.001), diabetes (34.4% vs. 23.2%; p = 0.004), Killip class 3 or 4 (13.1% vs. 7.4%; p < 0.02), and longer door-to-balloon time (1.4 hour [1.0-1.9 hour] vs. 1.1 hour [0.8-1.5 hour]; p < 0.001). The TIMI 3 post flow did not show any difference between the groups (86% vs. 90.7%; p = 0.08), but the Blush 3 post was lower (59.3% vs. 70.9%; p = 0.01) in the elderly. Angiographic success was obtained in 92.0% vs. 95.6%; p = 0.07. Temporary pacemakers, severe arrhythmias, and aborted sudden death were more frequently observed in patients aged ≥ 80 years. The rates of major adverse cardiovascular events and death at 30 days were higher in the older group (32.2% vs. 11.5% and 29.7% vs. 7.2%; p < 0.001 ). Conclusions: In this contemporary analysis, patients aged ≥ 80 years undergoing primary PCI had a more severe clinical and angiographic profile, longer door-to-balloon time, lower final Blush 3, with higher rates of hospital complications and 30-day mortality when compared with younger patient

Resultados iniciais e tardios de pacientes tratados com stent híbrido eluidor desirolimus ou stent eluidor de everolimus / Early and late outcomes of patients treated with hybrid sirolimus-eluting stent or everolimus-eluting stent

Introdução: O stent Orsiro é um stent híbrido que possui revestimentos passivo (carbeto de silício amorfo)e ativo (ácido poli-L-lático, PLLA). O primeiro encapsula as hastes do stent, promovendo menor inflamação local, e o segundo libera o sirolimus por meio de matriz biodegradável. Nosso objetivo foi comparar os resultados das intervenções coronárias percutâneas (ICP) dos stents Orsiro e Xience® V (eluidor de everolimus) na prática clínica diária. Métodos: Estudo observacional em que os pacientes foram alocados em dois grupos: os que e ceberam exclusivamente um ou mais stents Orsiro e os que receberam exclusivamente stents Xience® V. Desfechos iniciais e tardios foram prospectivamente coletados. Resultados: Entre setembro de 2012 e março de 2014, incluímos 92 e 108 pacientes tratados com stent Orsiro e Xience® V, respectivamente. Características clínicas, angiográficas e do procedimento foram, em sua maioria, semelhantes entre os grupos. As taxas de sucesso do procedimento (98,9% vs. 95,4%; p = 0,22), mortalidade (1,1% vs. 0%; p = 0,40) e trombose do stent (0% vs. 0,9%; p = 0,30) hospitalares não diferiram entre os grupos. O tempo de seguimento foi de 434 ± 111 e 477 ± 66 dias (p = 0,23), respectivamente, não sendo observadas diferenças na mortalidade (0,9% vs. 0%; p = 0,30), trombose do stent (0% vs. 0,9%; p = 0,30)e nem na necessidade de revascularização da lesão alvo (0% vs. 0,9%; p = 0,30). Conclusões: Os stents Orsiro e Xience® V apresentaram desempenho semelhante, com baixas taxas de eventos clínicos e angiográficos iniciais e tardios.

Background: The Orsiro is a hybrid stent which has passive (amorphous silicon carbide) and active(poly-L-lactic acid, PLLA) coatings. The first layer encapsulates the stent struts, promoting lower local inflammation, where as the second layer releases sirolimus through a biodegradable matrix. This study’saim was to compare the results of percutaneous coronary interventions (PCI) with Orsiro and Xience™ Vstents (everolimus-eluting stent) in daily clinical practice. Methods: Observational study in which patients were divided into two groups: those who received only one or more Orsiro stents, and those who received only XienceTM V stents. Early and late outcomes were prospectively collected. Results: Between September 2012 and March 2014, this study included 92 and 108 patients treated with Orsiro and Xience™ V stents, respectively. Clinical, angiographic, and procedure characteristics were mostly similar between groups. Rates of procedure success (98.9% vs. 95.4%; p = 0.22), in-hospital mortality (1.1% vs. 0%; p = 0.40) and stent thrombosis (0% vs. 0.9%, p = 0.30) did not differ between groups. Time of follow-up was 434 ± 111 and477 ± 66 days (p = 0.23), respectively, and differences in mortality (0.9% vs. 0%, p = 0.30), stent thrombosis (0% vs.0.9%; p = 0.30), or need for repeat revascularization of the target lesion (0% vs. 0.9%; p = 0.30) were not observed. Conclusions: Orsiro and Xience™ V stents showed similar performance, with low rates of early and late clinical and angiographic events.

Impacto da cirurgia de revascularização miocárdica prévia em desfechos clínicos de pacientes submetidos à intervenção coronária percutânea primária / Impact of prior coronary bypass graft surgery on the outcomes of patients undergoing primary percutaneous coronary intervention

Introdução: Historicamente, pacientes com cirurgia de revascularização do miocárdio (CRM) prévia submetidos à intervenção coronária percutânea (ICP) primária têm pior prognóstico que pacientes semCRM prévia. No entanto, análises mais contemporâneas contestam esses achados. Nosso objetivo foi avaliar os desfechos clínicos de 30 dias em pacientes com e sem CRM prévia submetidos à ICP primária. Métodos: Estudo de coorte prospectivo extraído do banco de dados do Instituto de Cardiologia do RioGrande do Sul, contendo 1.854 pacientes submetidos à ICP primária. Resultados: Pacientes com CRM prévia (3,8%) mostraram perfil clínico, em geral, mais grave. O tempo deinício dos sintomas até a chegada ao hospital foi menor nesse grupo (2,50 horas [1,46-3,66] vs. 3,99 horas[1,99-6,50]; p < 0,001) e o tempo porta-balão foi semelhante (1,33 hora [0,85-2,07] vs. 1,16 hora [0,88-1,58];p = 0,12). O acesso femoral foi mais usado no grupo com CRM prévia (91,5% vs. 62,5%; p < 0,001). O uso de tromboaspiração manual foi menor nesse grupo (16,9% vs. 31,1%; p = 0,007), mas não houve diferença no uso de inibidor da glicoproteína IIb/IIIa (28,2% vs. 32,4%; p = 0,28). O sucesso angiográfico foi menor no grupo com CRM prévia (80,3% vs. 93,3%; p = 0,009). Aos 30 dias, pacientes com CRM prévia apresentaram taxas similares de eventos cardíacos adversos maiores (14,1% vs. 11,2%; p = 0,28), e a mortalidade, embora numericamente mais alta, não foi estatisticamente significativa (13,2% vs. 7,0%; p = 0,07).Conclusões: Nessa análise contemporânea, pacientes com CRM prévia submetidos à ICP primária apresentaram perfil clínico mais grave e menor sucesso angiográfico, porém não mostraram diferenças nos desfechos clínicos em 30 dias.

Background: Historically, patients with prior coronary artery bypass graft (CABG) surgery undergoing primary percutaneous coronary intervention (PCI) have a worse prognosis than patients without prior CABG. However, more contemporary analyses have contested these findings. This study’s aim was to evaluate the 30-day clinical outcomes in patients with and without prior CABG submitted to primary PCI. Methods: Prospective cohort study, extracted from the database of Instituto de Cardiologia do Rio Grandedo Sul, containing 1,854 patients undergoing primary PCI. Results: Patients with prior CABG (3.8%) showed, in general, a more severe clinical profile. The time of symptom onset until arrival at the hospital was shorter in this group (2.50 hours [1.46 to 3.66] vs. 3.99 hour [1.99 to 6.50]; p < 0.001), while the door-to-balloon time was similar (1.33 hour [0.85 to 2.07] vs.1.16 hour [0.88 to 1.58]; p = 0.12). Femoral access was more often used in the group with prior CABG(91.5% vs. 62.5%; p < 0.001). Manual thrombus aspiration was less often performed in this group (16.9% vs. 31.1%; p = 0.007), but there was no difference regarding the use of glycoprotein IIb/IIIa inhibitors (28.2% vs. 32.4%, p = 0.28). Angiographic success was lower in the group with prior CABG (80.3% vs. 93.3%; p = 0.009). At 30 days, patients with prior CABG had similar rates of major adverse cardiac events (14.1%vs. 11.2%; p = 0.28), and mortality, although numerically higher, was not statistically significant (13.2%vs. 7.0%, p = 0.07). Conclusions: In this contemporary analysis, patients with prior CABG undergoing primary PCI had amore severe clinical profile and lower angiographic success, but showed no differences regarding 30-day clinical outcomes.

Padrão de exposição radiológica em profissionais da saúde durante procedimentos cardiológicos invasivos / Pattern of radiation exposure in healthcare professionals during coronary angiography

Introdução: Procedimentos cardiológicos invasivos expõem Médicos e enfermeiros/técnicos de enfermagem aos riscos da radiação ionizante. O objetivo deste estudo foi determinar os padrões de exposição radiológica em profissionais da saúde durante procedimentos cardiológicos. Métodos: Estudo prospectivo incluindo pacientes submetidos a procedimento cardiológico invasivo entre dezembro de 2011 e agosto de 2012 em equipamento com detectores do tipo plano. Características clínicas, angiográficas e de exposição à radiação foram registradas em banco de dados específico. Os padrões de exposição à radiação foram determinados em pacientes submetidos ao cateterismo cardíaco diagnóstico. Correlação entre dose do médico operador e enfermeiro/técnico de enfermagem também foi efetuada. Resultados: Amostra incluiu 119 pacientes submetidos ao cateterismo. A dose de kerma no ar e o produto dose-área médio de radiação recebida pelos pacientes foram de 549 ± 220 mGy e 29.054 ± 14.696 mGy.cm2, respectivamente. Médicos e enfermeiros/técnicos de enfermagem foram expostos à dose efetiva média por exame de 0,47 ± 0,16 e 0,28 ± 0,13 mSv, respectivamente. A correlação entre dose efetiva dos Médicos e enfermeiro/técnicos de enfermagem foi de 0,54 ( p < 0,001). Conclusões: Médicos e enfermeiros/técnicos de enfermagem são expostos a doses pequenas de radiação ionizante durante cateterismo cardíaco diagnóstico. Enfermeiros/técnicos de enfermagem são expostos a cerca de 60% da dose do médico operador...

Background: Invasive cardiologic procedures expose physicians and nurses/technicians to the risks of ionizing radiation. The aim of this study was to determine the exposure patterns in healthcare professionals during cardiologic procedures. Methods: Prospective study including patients undergoing invasive cardiologic procedures between December 2011 and August 2012 using flat-panel detector fluoroscopy. Clinical, angiographic and radiation exposure characteristics were recorded in a dedicated database. Patterns of radiation exposure were determined in patients undergoing diagnostic cardiac catheterization. The correlation between surgeon and nurse/technician dose was also evaluated. Results: The sample included 119 patients undergoing catheterization. The patient mean air kerma dose and dose-area product was 549 ± 220 mGy and 29,054 ± 14,696 mGy.cm2, respectively. Physicians and nurses/technicians were exposed to a mean effective dose of 0.47 ± 0.16 and 0.28 ± 0.13 mSv per exam, respectively. The correlation between physicians and nurses/technicians effective dose was 0.54 (p < 0.001). Conclusions: Physicians and nurses/technicians are exposed to low ionizing radiation doses during diagnostic cardiac catheterization. Nurses/technicians are exposed to approximately 60% of the operating physician's dose...

Resultados das Intervenções Coronárias Percutâneas Primárias Realizadas nos Horários Diurno e Noturno / Results of Primary Percutaneous Coronary Interventions Performed During On- and Off-Hours

Introdução: Estudos demonstram que a intervenção coronária percutânea primária realizada fora do horário de rotina está relacionada a pior prognóstico. Nosso objetivo foi avaliar os desfechos da intervenção coronária percutânea primária realizada nos períodos diurno e noturno em um centro cardiológico de referência. Métodos: Estudo de coorte prospectivo, que incluiu 1.108 pacientes consecutivamente atendidos por infarto agudo do miocárdio com supradesnivelamento do segmento ST, divididos nos grupos intervenção coronária percutânea primária diurna (se realizada entre 8 e 20 horas) e intervenção coronária percutânea primária noturna (se realizada entre 20 e 8 horas). Resultados: Incluímos 680 pacientes no grupo diurno e 428 no grupo noturno. As características basais referentes ao perfil demográfico, fatores de risco e classificação Killip foram semelhantes em ambos os grupos, porém o tempo porta-balão foi significativamente maior no grupo noturno (84 ± 66 minutos vs. 102 ± 98 minutos; p < 0,01). Vasos culpados, e fluxos TIMI pré e pós-procedimento não foram diferentes entre os grupos. Não encontramos diferenças significantes em relação à mortalidade hospitalar (7,6% vs. 10,2%; p = 0,16), trombose de stent (2,8% vs. 2,4%; p = 0,69) ou presença de sangramento maior (1,9% vs. 2,1%; p = 0,50). Em 1 ano, a mortalidade também foi semelhante (9,5% vs. 12,6%; p = 0,12). O principal preditor de mortalidade em 1 ano foi a classe III/IV de Killip (OR = 10,02; IC 95% 5,8-17,1; p < 0,01). Conclusões: Pacientes com infarto agudo do miocárdio apresentam taxas de desfechos clínicos semelhantes, independentemente do horário de realização da intervenção coronária percutânea primária. No entanto, o tempo porta-balão é significativamente maior nos pacientes tratados entre 20 e 8 horas.

Background: Previous studies have shown that off-hours primary percutaneous coronary interventions are related to a worse prognosis. The objective of this study was to evaluate the outcomes of patients undergoing on- and off-hours primary percutaneous coronary interventions performed at a reference cardiology center. Methods: Prospective cohort study, including 1,108 consecutive patients with ST elevation myocardial infarction divided into primary percutaneous coronary intervention performed during regular working hours group (on-hours: 8:00 am to 8:00 pm) and primary percutaneous coronary intervention during nonregular working hours group (off-hours: 8:00 pm to 8:00 am). Results: The sample included 680 patients in the on-hours group and 428 in the off-hours group. Baseline demographic data, risk factors and Killip classification were similar in both groups, however door-to-balloon time was significantly longer in the off-hours group (84 ± 66 minutes vs. 102 ± 98 minutes; p < 0.01). Culprit vessels, pre- and post-procedure TIMI flows were not different between groups. There were no significant differences for in-hospital mortality (7.6% vs. 10.2%; p = 0.16), stent thrombosis (2.8% vs. 2.4%; p = 0.69) or major bleeding (1.9% vs. 2.1%; p = 0.50). One-year mortality was also similar (9.5% vs. 12.6%; p = 0.12). The main predictor of mortality at 1 year was Killip III/IV (OR, 10.02; 95% CI, 5.8-17.1; p < 0.01). Conclusions: Patients with myocardial infarction have similar in-hospital clinical outcomes regardless of the time primary percutaneous coronary intervention is performed. However, door-to-balloon time is significantly longer in patients treated during off-hours.

Xenotransplantation of human unrestricted somatic stem cells in a pig model of acute myocardial infarction.

BACKGROUND: Stem cell therapy may help restore cardiac function after acute myocardial infarction (AMI), but the optimal therapeutic cell type has not been identified. METHODS: We examined the effects of CD34-/CD45- human unrestricted somatic stem cells (USSCs) in pigs (n = 30) with an AMI created by a 90-min occlusion of the left anterior descending coronary artery. Pigs were randomly assigned to receive either USSCs (302 ± 23 × 10(6) cells) or phosphate-buffered saline via 15 NOGA-guided transendocardial injections 10 days after AMI. Cyclosporine A (10 mg/kg orally, twice a day) was started in all pigs 3 days before control or cell treatment. Cardiac function was assessed by echocardiography before injection and at 4 and 8 weeks after treatment. Serum titers for pig IgG antibodies against USSCs were also measured at these time points and before AMI. RESULTS: Compared with control pigs, USSC-treated pigs showed no significant differences in any of the functional parameters examined. USSC-treated pigs showed variable increases in anti-USSC IgG antibody titers in the blood and chronic inflammatory infiltrates at the cell injection sites. Immunohistochemical studies of the injection sites using human anti-mitochondrial antibodies failed to detect implanted USSCs. CONCLUSIONS: We conclude that human USSCs did not improve cardiac function in a pig model of AMI. Cell transplantation in a xenogeneic setting may obscure the benefits of stem cell therapy.

Impacto das lesões complexas na exposição radiológica durante intervenção coronária percutânea / Impact of complex lesions on radiological exposure during percutaneous coronary intervention

INTRODUÇÃO: Intervenções coronárias percutâneas (ICPs) em lesões complexas são cada vez mais comuns na prática diária. O objetivo deste estudo foi determinar o impacto das lesões complexas na exposição radiológica durante ICP. MÉTODOS: Estudo de coorte prospectiva incluindo pacientes submetidos a ICP entre agosto de 2010 e dezembro de 2011. Características clínicas, angiográficas e de exposição à radiação foram registradas em banco de dados específico. Os padrões de exposição à radiação (dose total recebida, tempo de fluoroscopia e produto dose-área) foram determinados em pacientes submetidos a ICP de lesões não-complexas (A/B1) e complexas (B2/C). Os dados foram analisados em programa SPSS 18.0. Preditores independentes de exposição à radiação foram determinados por regressão logística múltipla. RESULTADOS: Foram analisadas 413 ICPs, sendo 83 lesões no grupo A/B1 e 330 no grupo B2/C. Não ocorreram diferenças clínicas significativas entre os grupos. A mediana de radiação recebida pelos pacientes foi significativamente maior no grupo B2/C (1.103,9 mGy vs. 866,6 mGy; P < 0,01). O produto dose-área (43.484 mGy.cm² vs. 58.327 mGy.cm²; P < 0,001) e o tempo de fluoroscopia (9 ± 6 minutos vs. 12,1 ± 9,5 minutos; P = 0,001) também foram significativamente maiores no grupo B2/C. Os preditores de exposição radiológica aumentada foram peso [razão de chance (RC) 1,02 para cada aumento de 1 kg, intervalo de confiança (IC) 1,01-1,036; P = 0,004] e lesão tipo B2/C (RC 1,9, IC 1,002-4,96; P = 0,002). CONCLUSÕES: Pacientes submetidos a ICP em lesões complexas são significativamente mais expostos à radiação. Peso e tipo de lesão (B2/C) são preditores de exposição radiológica aumentada.

BACKGROUND: Percutaneous coronary interventions (PCIs) in complex lesions are increasingly common in daily practice. The objective of this study was to determine the impact of complex lesions on radiological exposure during PCI. METHODS: Prospective cohort study including patients undergoing PCI between August 2010 and December 2011. Clinical, angiographic and radiation exposure characteristics were recorded in a dedicated database. Patterns of radiation exposure (total dose received, fluoroscopy time and dose-area product) were determined in patients undergoing PCI for non-complex (A/B1) and complex (B2/C) lesions. Data were analyzed by the SPSS 18.0 program. Independent radiation exposure predictors were determined by multiple logistic regression. RESULTS: We analyzed 413 PCIs, 83 lesions in group A/B1 and 330 in group B2/C. There were no clinically significant differences between groups. The median radiation dose received by patients was significantly higher in group B2/C (1,103.9 mGy vs 866.6 mGy; P < 0.01). The dose-area product (43,484 mGy.cm² vs 58,327 mGy.cm²; P < 0.001) and fluoroscopy time (9 ± 6 minutes vs 12.1 ± 9.5 minutes; P = 0.001) were also significantly higher in group B2/C. Predictors of increased radiation exposure were weight [odds ratio (OR) 1.02 for each increase of 1 kg, confidence interval (CI) 1.01-1.036; P = 0.004], type B2/C lesion (OR 1.9, CI 1.002-4.96; P = 0.002). CONCLUSIONS: Patients undergoing PCI in complex lesions are significantly more exposed to radiation. Weight and lesion type (B2/C) are predictors of increased radiation exposure.