Altered cardiac repolarization in association with air pollution and air temperature among myocardial infarction survivors.

BACKGROUND: Epidemiological studies have shown that ambient particulate matter (PM) and changes in air temperature are associated with increased cardiopulmonary events. OBJECTIVE: We hypothesized that patients with previous myocardial infarction (MI) experience changes in heart rate (HR) and repolarization parameters, such as Bazett-corrected QT interval (QTc), and T-wave amplitude (Tamp), in association with increases in air pollution and temperature changes. METHODS: Between May 2003 and February 2004, 67 MI survivors from the Augsburg KORA-MI registry repeatedly sent 16 sec electrocardiograms (ECGs) with a personal transmitter (Viapac) via telephone to the Philips Monitoring Center, where ECG parameters were immediately analyzed. Meteorological data and air pollutants were acquired from fixed monitoring sites on an hourly basis. Additive mixed models were used for analysis. Effect modification by patient characteristics was investigated. RESULTS: The analysis of the 1,745 ECGs revealed an increased HR associated with interquartile range (IQR) increases in PM levels among participants not using beta-adrenergic receptor blockers and among those with body mass index ≥ 30 kg/m². We observed a 24- to 47-hr lagged QTc prolongation [0.5% change (95% confidence interval, 0.0-1.0%)] in association with IQR increases in levels of PM ≤ 2.5 µm in aerodynamic diameter, especially in patients with one [0.6% (0.1-1.0%)] or two [1.2% (0.4-2.1%)] minor alleles of the nuclear factor (erythroid-derived 2)-like 2 (NFE2L2) single-nucleotide polymorphism rs2364725. Positive immediate (0-23 hr) and inverse delayed (48-71 hr up to 96-119 hr) associations were evident between PM and Tamp. We detected an inverse U-shaped association between temperature and Tamp, with a maximum Tamp at 5°C. CONCLUSIONS: Increased air pollution levels and temperature changes may lead to changes in HR and repolarization parameters that may be precursors of cardiac problems.

Reliability of an external loop recorder for automatic recognition and transtelephonic ECG transmission of atrial fibrillation.

In order to test a newly developed algorithm for detecting atrial fibrillation in clinical practice, we carried out parallel recordings using a conventional 24-h electrocardiogram (ECG) monitor and telemonitoring with an external loop recorder. Recordings were made in 24 patients with persistent atrial fibrillation and in another 24 patients with sinus rhythm. Atrial fibrillation was detected immediately in 23 of 24 patients with persistent atrial fibrillation and 20 min after fitting the single-channel loop recorder in the 24th patient (sensitivity 100%). On average, 3.1 false positives (i.e. detection of an episode, including the end or beginning of atrial fibrillation) were transmitted per patient. The sensitivity of the algorithms for automatically detecting bradycardiac and tachycardiac atrial fibrillation was also high. In 12 of 24 patients with sinus rhythm, false-positive tele-ECGs were transmitted. These were caused by supraventricular or ventricular extrasystoles and by sinus arrhythmias or sinoatrial (SA) blocks. The external loop recorder was very effective at detecting paroxysmal atrial fibrillation. Possible indications for the clinical use of this recorder include, in addition to diagnosis, monitoring patients for atrial fibrillation recurrence after cardioversion or catheter ablation.

[Telemonitoring of cardiovascular diseases in Germany. Standing position and perspectives]. / Telemonitoring bei Herz-Kreislauf-Erkrankungen in Deutschland: Stand und Perspektiven.

The changes in the demographic structure, the increasing multimorbidity in connection with a rise in the number of chronic illnesses and the absence of an effective coordination of the different levels of healthcare services with its discontinuous processes and redundancies will lead to intolerable economic burdens in the German health-care system, affecting medical, health-political and economic dimensions alike. This is the significance in terms of content and strategy of "health telematics" as an application of modern telecommunication and information technologies in the health-care system, and of "E-Health" as a specification of all services, quality improvements and rationalization effects, which are achievable by digitizing data collection as well as communication processes. Not only do digitizing and electronic transmission offer a better, faster and safer way of communication, but by possibilities of combining data they also allow the rationalization and quality-improving introduction of new methods of diagnosis, therapy and aftercare. The latest developments and appropriate logistic premises nowadays offer a realistic basis for implementing telemonitoring as a central service and information tool as well as an instrument controlling the information and data flow between patient, hospital and medical practitioner. Considering the enormous significance of cardiovascular diseases, focusing on corresponding cardiologic disease patterns seems almost self-evident. Notwithstanding remarkable medical progress during the past few years, cardiovascular diseases are still the number one cause of death in industrialized countries. In the cardiologic sector, telemedical systems are most commonly used with patients suffering from coronary heart diseases, e.g., for the detection of unclear dysrhythmia, as well as with patients suffering from chronic heart failure. Seen from a medical point of view, it is paramount to judge the clinical situation without delay as well as to take necessary therapeutic measures timely and to control their efficiency over a long period of time.Consequently, telemedical projects include the establishment of a nonstop monitoring of patients with increased or high risk of cardiovascular incidents, starting with the hospitalization, postoperative/post in-house health care and up to home care. This kind of monitoring needs to be adjustable to the respective situation modularly in order to guarantee a smooth possibility of surveillance both in the stationary and the ambulant sector, which, in addition, has to be individually adjustable to the demand of required monitoring functions (heart rate, blood pressure, S-T segments, oxygen satiation, weight, breathing rate, and temperature) and the intensity of the monitoring (event recording, "on-demand" vs. continuous monitoring). Certainly rich in meaning for the future is the integrated telemedicine care of a "primary" cardiac patient with his relevant comorbidities: diabetes and coagulation monitoring, respectively.

Highly characteristic and individual specific telomere length patterns in cattle.

A combined primed in situ labelling (PRINS)/4',6-diamino-2-phenylindole (DAPI)/propidium iodide (PI)-fluorescence-banding method was used to characterise telomeres, identify their specific chromosomes and visualise neighbouring heterochromatin in 25 artificial insemination (AI) bulls. A highly heterogeneous telomere length pattern was found in cattle. Each bull possessed his own characteristic, specific telomere length pattern.

Telecardiology for patients with acute or chronic cardiac complaints: the 'SHL' experience in Israel and Germany.

OBJECTIVE: To assess the impact of a telemedicine program in which electrocardiogram (EKG), body weight and/or blood pressure are measured at home and medically trained personnel judge the transmitted data and council the patients by telephone. METHOD: We systematically studied the outcome and cost-effectiveness of the cardiac programs carried out by Shahal (SHL) during the past 19 years. RESULT: Most patients (85%) with acute complaints resembling coronary artery disease, could be reassured, representing a savings of about 677.000 euro per 10,000 members/yr in Israël in 1989, and a marked reduction in patient delay to 44 min (median). In chronic heart failure a 66% reduction in hospitalisation days was observed, together with an improvement in quality of life. A large Healthcare Insurance Company in Germany (Taunus BKK) has calculated that it can save at least 5 million euro per year with the use of such services. CONCLUSION: Disease management with concomitant telemedicine for coronary artery disease and chronic heart failure is safe and effective and has a huge potential for cost savings, improvements in quality of life and in prognosis of heart disease.

Myocardial infarction in coronary bypass surgery using on-pump, beating heart technique with pressure- and volume-controlled coronary perfusion.

BACKGROUND: Even with the current aerobic techniques in myocardial protection, perioperative myocardial infarction can still occur. In this study, we sought to find out whether there is a method-specific mechanism of ischemic injury in coronary bypass surgery using an on-pump beating heart technique. For this reason, we investigated localization and the extent of myocardial infarction in correlation to the severity of coronary artery stenosis. We discuss strategies for reduction of infarction incidence. METHODS: 34 patients, who after isolated coronary bypass procedure developed non-Q or Q wave infarction were selected for the study. In 12 of 34 patients (group A) beating heart technique and in 22 of 34 patients (group B) cardioplegic arrest was used for myocardial protection. The study was conducted retrospectively and included patients with stable, unstable, and postinfarction angina without preoperative enzymatic evidence of ischemic injury and with technically noncomplicated coronary bypass grafting. Excluded from the study were emergency and redo procedures. In group A, in all instances, the left anterior descending artery was grafted as the last vessel and while distal anastomoses were constructed, coronary perfusion was maintained by using a perfusion catheter. RESULTS: Most patients in both groups had triple-vessel disease (10 of 12 patients group A; 17 of 22 patients group B), all patients received complete revascularization; 7 of 12 patients in group A and 5 of 22 patients in group B had significant or critical left main stem stenosis. In group A, 11 infarctions occurred in LAD-(12 stenotic), 1 in CX-(11 stenotic), and 1 in RCA-(11 stenotic) supply area, four were Q wave infarctions. In group B, eight infarctions occurred in LAD (22 stenotic), four in CX (17 stenotic), and 14 in RCA (20 stenotic) supply area, eight were Q wave infarctions. In group A, the infarction incidence in the LAD area was 10-times higher than in CX and RCA areas. In group B, the infarction incidence in the RCA area was 2- and 3-times higher than in the LAD and CX areas, respectively. In both groups no correlation between infarction incidence and severity of stenosis was observed. CONCLUSIONS: Using an on-pump beating heart technique, higher coronary perfusion pressures, avoidance of extreme upward retraction of the heart during revascularization of the CX-branch, as well as choosing the revascularization of the LAD as the first vessel, could possibly contribute to better myocardial protection. In hearts arrested with cardioplegic solution, the right ventricle is probably more susceptible to ischemic injury, especially when RCA is poorly collateralized. For adequate protection, choosing the revascularization of the RCA as the first vessel with immediate repeated cardioplegia via a RCA graft, higher perfusion pressures and antegrade with retrograde cardioplegia delivery, may be advantageous.