Single limb electrocardiogram using vector mapping: Evaluation and validation of a novel medical device.

INTRODUCTION: The Tiger Tech Warfighter Monitor (WFM) is a novel single-limb device for ECG acquisition. The WFM provides true (not derived) single limb Electrocardiogram monitoring (ECG) to provide heart rate and R-R interval monitoring between QRS complexes. Herein, we evaluate the diagnostic accuracy of the WFM heart rate, R-R interval monitoring, and heart rate variability monitoring in comparison to a 2­lead chest ECG. METHODS: Data was collected under Institutional Review Board (IRB) approval. Patients available within our institution's pre-operative holding unit were randomly selected to undergo simultaneous chest and WFM ECG monitoring. 3-5-min measurements were taken depending on the patient's availability. Data was saved to two separate mobile phones and time-stamped for synchronization. A proprietary Tiger Tech extraction algorithm was used to tag proper features on both the WFM 1-Limb ECG and Chest ECG data files. A separate algorithm was then used to compare the beat-to-beat variations between the ECGs. RESULTS: Data was extracted and analyzed on 26 subjects. Linear regression of heart rate analysis revealed excellent correlations with an R2 of 0.99 (p < 0.05). Similar linear regression evaluation of R-R interval correlation demonstrated a mean R2 value of 0.95 (p < 0.05). Statistically significant correlation was achieved in all 26 included study participants. Heart rate variability also achieved excellent correlation (SDNN R2 = 0.997, RMSSD R2 = 0.995, LnRMSSD R2 = 0.992, p << 0.05). CONCLUSION: Results demonstrate that the WFM achieves excellent correlation with chest ECG for heart rate, R-R internals, and heart rate variability.

Heart Rate Variability as a Possible Predictive Marker for Acute Inflammatory Response in COVID-19 Patients.

INTRODUCTION: Increases in C-reactive protein (CRP) are used to track the inflammatory process of COVID-19 and are associated with disease state progression. Decreases in heart rate variability (HRV) correlate with worsening of disease states. This observational study tracks changes in HRV relative to changes in CRP in COVID-19 patients. MATERIALS AND METHODS: In accordance with an Institutional Review Board-approved study, 17 patients were followed using the wearable, noninvasive Tiger Tech Warfighter Monitor (WFM) that records HRV from a single limb electrocardiogram. Intermittent, daily short-segment data sets of 5 to 7 minutes over a minimum of 7 days were analyzed. Changes in HRV were compared to changes in CRP. RESULTS: Decreases in HRV of greater than 40% preceded a 50% increase in CRP during the ensuing 72 hours in 10 of the 12 patients who experienced a dramatic rise in CRP. The effectiveness of HRV as a leading indicator of a rise in CRP was evaluated; the sensitivity, specificity, positive predictive value, and negative predictive value for 40% decreases in HRV preceding 50% increases in CRP were 83.3%, 75%, 90.9%, and 60%, respectively. CONCLUSION: Substantial decreases in HRV preceded elevations in CRP in the ensuing 72 hours with a 90.9% positive predictive value. Early detection of increasing inflammation may prove vital in mitigating the deleterious effects of an abnormal inflammatory response, particularly in COVID-19 patients. This capability could have a major impact in triage and care of moderate to severe COVID-19 patients in major medical centers as well as field hospitals. This study demonstrates the potential value of short-segment, intermittent HRV analysis in COVID-19 patients.

Relationship between Serum Vitamin D Levels and HDL Cholesterol in Postmenopausal Women from Colombian Caribbean.

BACKGROUND: Previous evidence suggests that metabolic disorders in postmenopausal women could be related with low serum vitamin D levels. For example, vitamin D deficiency has been associated with increased risk factors for cardiovascular disease (CVD), mainly those related with metabolic syndrome. OBJECTIVE: To assess the relationship between the serum vitamin D (25-OH-D) levels and the metabolic syndrome markers in postmenopausal women. METHODS: This descriptive and cross-sectional study was conducted in 183 postmenopausal women of four municipalities from Colombian Caribbean. The serum 25-OH-D levels and the anthropometric and biochemical markers were assessed and correlated with metabolic syndrome. RESULTS: The average value of serum vitamin D (25-OH-D) was 26.34 ± 9.08 ng/mL, and 69.95% of the women had vitamin D levels <30 ng/mL, of which 43.72% were with insufficiency (<30 to >20 ng/mL) and 26.23% with deficiency (<20 ng/mL). Of the evaluated women, the 81.42% seemed to have metabolic syndrome. Through the linear regression, one significant positive association was observed between the HDL cholesterol and the 25-OH-D levels (P=0.014). CONCLUSION: In the evaluated population in this study, vitamin D deficiency is related with low HDL cholesterol levels.

Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation.

BACKGROUND: The optimal treatment for concomitant two-vessel coronary artery disease (CAD) and moderate to severe ischemic mitral regurgitation (IMR) remains unclear. We compared the results of a staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery (PCI+MIVS) versus combined coronary artery bypass graft and mitral valve surgery (CABG+MVS) in this population. METHODS: All consecutive patients with two-vessel CAD and moderate to severe IMR, who underwent PCI+MIVS or CABG+MVS at our institution between February 2009 and April 2014, were retrospectively evaluated. RESULTS: There were nine patients identified who underwent PCI+MIVS, and 15 who underwent CABG+MVS, with a mean age of 71±7, and 70±7 years, respectively (P=0.86). The remaining baseline characteristics were similar between both groups, with the exception of a higher prevalence of pre-operative clopidogrel administration (78% versus 27%, P=0.03) and left anterior descending plus left circumflex CAD (78% versus 27%, P=0.03), in those who underwent PCI+MIVS. The PCI+MIVS approach was associated with decreased mean cardiopulmonary bypass (111±41 versus 167±49 min, P=0.01) and aortic cross-clamp (79±32 versus 129±35 min, P=0.003) times, and less median number of intraoperative packed red blood transfusions {2 [interquartile range (IQR), 0-2] versus 3 units (IQR, 1-4), P=0.05}, when compared with CABG+MVS. The rate of mitral valve repair, postoperative complications, 30-day mortality, and 1-year survival did not differ between the surgical approaches. CONCLUSIONS: PCI+MIVS for two-vessel CAD and moderate to severe IMR is feasible, and associated with satisfactory outcomes, as compared with CABG+MVS.

Ingesta alimentaria y estado nutricional de pacientes con enfermedad de chagas / Dietary intake and nutritional status of patients with Chagas disease

La enfermedad de Chagas es una infección parasitaria que afecta a 17 millones de personas en Latinoamérica. Es aún desconocida la real influencia del efecto del estado nutricional y la ingesta alimentaria sobre la evolución de la enfermedad hacia la miocardiopatía chagásica crónica, así como los factores de riesgo cardiovascular que pueden influir en la evolución de la patología. Con el objetivo de caracterizar la ingesta alimentaria y determinar el estado nutricional de las personas con enfermedad de Chagas, se llevó a cabo un estudio descriptivo transversal de una muestra de pacientes atendidos en el servicio de cardiología del Hospital Centenario de Rosario. Se recolectaron datos sobre las características generales de la muestra, se realizaron mediciones antropométricas y se entrevistó sobre el consumo de alimentos a través de un cuestionario de frecuencia de consumo y un atlas fotográfico. Se reclutaron 113 paciente, de los cuales el 70% de los hombres y el 90 % de las mujeres presentaban sobrepeso u obesidad. Además el 78.9% de las mujeres y el 27% de los hombres, presento un Índice cintura/cadera de riesgo cardiovascular. En el análisis de la ingesta de macronutrientes se observa que se superan las recomendaciones del aporte de lípidos. Al analizar la ingesta de alimentos por grupos se encontró que los hombres consumen más carne vacuna magra, fiambres y embutidos, carne de cerdo y bebidas alcohólicas, en cambio las mujeres ingieren más lácteos enteros y bebidas azucaradas. Esta muestra urbana de pacientes con enfermedad de Chagas, presenta un perfil nutricional similar al de la población general, y el consumo alimentario se encuentra influenciado por la vida en las grandes ciudades(AU)

Chagas disease is a parasitic infection that affects 17 million people in Latin America. The real influence of nutritional status and food intake effect over the course of the disease to chronic Chagas Cardiomyopathy is still unknown. Furthermore, some cardiovascular risk factors might influence the evolution of the disease. A cross-sectional study of a sample of patients with Chagas disease attending the Cardiology Section of the Hospital Centenario of Rosario was carried out in order to characterize their food intake and nutritional status. Data on the general characteristics of the sample was collected; anthropometric measurements were performed and food consumption was investigated using a food frequency questionnaire and a n photographic atlas. One hundred and thirteen patients were enrolled; 70% of men and 90% of women were overweight or obese. In addition 78.9% of women and 27% of men presented a waist-hip ratio according to cardiovascular risk. When analyzing macronutrient intake, it was observed that lipid intake recommendations were exceeded. When the food intake groups were analyzed separately, it was found that men consume more lean beef, cold cuts, pork and alcoholic drinks, while women eat more whole dairy products and sugary drinks. This patients´ urban sample with Chagas disease, he presents a nutritional profile similar to that of the general population, and the food consumption is influenced by life in big cities(AU)

Dietary intake and nutritional status of patients with Chagas disease.

Chagas disease is a parasitic infection that affects 17 million people in Latin America. The real influence of nutritional status and food intake effect over the course of the disease to chronic Chagas Cardiomyopathy is still unknown. Furthermore, some cardiovascular risk factors might influence the evolution of the disease. A cross-sectional study of a sample of patients with Chagas disease attending the Cardiology Section of the Hospital Centenario of Rosario was carried out in order to characterize their food intake and nutritional status. Data on the general characteristics of the sample was collected; anthropometric measurements were performed and food consumption was investigated using a food frequency questionnaire and a n photographic atlas. One hundred and thirteen patients were enrolled; 70% of men and 90% of women were overweight or obese. In addition 78.9% of women and 27% of men presented a waist-hip ratio according to cardiovascular risk. When analyzing macronutrient intake, it was observed that lipid intake recommendations were exceeded. When the food intake groups were analyzed separately, it was found that men consume more lean beef, cold cuts, pork and alcoholic drinks, while women eat more whole dairy products and sugary drinks. This patients´ urban sample with Chagas disease, he presents a nutritional profile similar to that of the general population, and the food consumption is influenced by life in big cities.

Combined Mitral and Tricuspid Valve Surgery Performed via a Right Minithoracotomy Approach.

OBJECTIVE: Combined mitral and tricuspid valve surgery is associated with an increased perioperative morbidity and mortality. We evaluated the outcomes of a less invasive right minithoracotomy approach in patients undergoing primary or reoperative double-valve surgery. METHODS: We retrospectively evaluated 132 consecutive patients with mitral and tricuspid valve disease who underwent double-valve surgery via a right minithoracotomy at our institution between January 2009 and April 2014. RESULTS: The cohort included 81 female (61%) and 51 male (39%) patients, with a mean ± SD age of 67 ± 13 years. The mean ± SD preoperative left ventricular ejection fraction, mitral regurgitation grade, and creatinine were 53% ± 12%, 3.8 ± 0.6, and 1.26 ± 1.17, respectively. The patients underwent primary (88%) or reoperative (12%) mitral and tricuspid valve surgery, which consisted of 88 mitral repairs (67%), 44 mitral replacements (33%), 131 tricuspid repairs (99%), and 1 tricuspid replacement (1%). Postoperatively, there were 6 cases of acute kidney injury (5%), 6 reoperations for bleeding (5%), 4 cerebrovascular accidents (3%), and 12 cases of atrial fibrillation (9%). The median intensive care unit length of stay and total hospital lengths of stay were 61 hours (interquartile range, 43-112 hours) and 8 days (interquartile range, 6-13 days), respectively. The in-hospital mortality was 4%. Actuarial survival at 1 and 5 years was 93% and 88%, respectively. CONCLUSIONS: In patients undergoing primary or reoperative mitral and tricuspid valve surgery, a right minithoracotomy approach is associated with a low perioperative morbidity and good midterm survival.

Successful immunotherapy of canine flea allergy with injected Actinomycetales preparations.

AIMS: Can heat-killed, borate-buffered suspensions of Gordonia bronchialis, Rhodococcus coprophilus or Tsukamurella inchonensis be used to treat canine flea allergy? MATERIALS & METHODS: Organisms cultured on Sauton's medium into stationary phase were autoclaved in borate-buffered saline and stored at 10 mg wet weight/ml. Intradermal injections of 0.1 ml containing 1 mg of bacilli were administered on the first and 20th days of the study. G. bronchialis and R. coprophilus were most effective in a pilot study of a small number of dogs with flea allergy. A larger number of affected dogs were then randomized to receive placebo or either of the two selected reagents. The extent and severity of allergic signs and symptoms were scored and blood samples were collected just before the first injection and 28 days after the second. RESULTS: Both selected reagents reduced the extent and severity of lesions (p < 0.001) and reduced scratching. Eosinophil numbers were reduced (p < 0.0001) between the first and second assessment. CONCLUSIONS: Injections of G. bronchialis or R. coprophilus effectively reduce the signs and symptoms of flea allergy in dogs.

Maternal immunization with actinomycetales immunomodulators reduces parasitemias in offspring challenged with Trypanosoma cruzi.

This article describes the first use of heat-killed, borate-buffered preparations of aerobic actinomycetales to immunize pregnant animals in order to determine the effect on their pregnancy and fertility and the survival coefficients of their offspring. Pregnant rats received three injections of Gordonia bronchialis, Rhodococcus coprophylus or physiological saline and a proportion of their offspring were challenged with live Trypanosoma cruzi at the time of weaning. Levels of parasitemia and, in some animals, of the cytokines IFN-γ and IL-10 were measured. The progress of pregnancy, fertility and survival of offspring were unaffected by the maternal immunizations. The offspring of rats immunized with G. bronchialis displayed significantly reduced parasitemias, with increased levels of IFN-γ and reduced levels of IL-10, 4 days after challenge. The offspring of rats immunized with R. coprophylus displayed greater parasitemias than did those of the control group. These unexpected results are discussed and their causation considered.

Electrocardiographic alteration among first degree relatives with serologic evidence of Trypanosoma cruzi infection. A sibship study

To analyze whether electrocardiographic alterations (ECGA) in patients with antibodies to Trypanosoma cruzi showed a patttern of familial aggregation, a sample of 379 young adults (166 men and 213 women) distributed in sibships, were assessed for the presence of anti-T.cruzi antibodies, and subjected to a complete clinical examination and a standard resting electrocardiogram (ECG). Positive T. cruzi serology was detected in 165 individuals, 48 of them showing an abnormal ECG (overall prevalence 29 por cento). One hundred and eleven seropositive individuals were distributed in 45 sibships, each of them constituted by more than one seropositive sib, with ECGA being present in 34 out of these patients. Seropositive subjects with ECGA were detected in 27 sibships. Since the index case within each sibship is counted exactly once, affected individuals selected at random as propositi were extracted to calculate the prevalence of ECGA among first degree relatives of probands. Abnormal ECGs were recorded in 7 out of 45 sibs yielding a prevalence that did not differ from estimations registered in the general population or seropositive sibs. Data from the present sample show no familial aggregation for the occurrence of ECGA in patients with T.cruzi infection.