RESUMO
Background: In patients with pulmonary hypertension (PH), increased pulmonary vascular resistance (PVR) may lead to increased right ventricular afterload and cardiac remodelling, potentially providing the substrate for ventricular arrhythmias. Studies dealing with long term monitoring of patients with PH are rare. The present study evaluated the incidence and the types of arrhythmias retrospectively recorded by Holter ECG in patients with newly detected PH during a long-term Holter ECG follow-up. Moreover, their impact on patient survival was evaluated. Patients and methods: Medical records were screened for demographic data, aetiology of PH, incidence of coronary heart disease, level of brain natriuretic peptide (BNP), results from Holter ECG monitoring, 6-minute walk test distance, echocardiographic data and hemodynamic data derived from right heart catheterization. Two subgroups were analyzed: 1. patients (n = 65) with PH (group 1 + 4) and derivation of at least 1 Holter ECG within 12 months from initial detection of PH and 2. patients (all PH etiologies, n = 59) with 3 follow-up Holter ECGs. The frequency and complexity of premature ventricular contractions (PVC) was classified into "lower" and "higher" (=non sustained ventricular tachycardia, nsVT) burden. Results: Holter ECG revealed sinus rhythm (SR) in most of the patients (n = 60). Incidence of atrial fibrillation (AFib) was low (n = 4). Patients with premature atrial contractions (PAC) tend to have a shorter period of survival (p = 0.098), PVC were not correlated with significant survival differences. During follow-up PAC and PVC were common in all PH groups. Holter ECG revealed non sustained ventricular tachycardia in 19/59 patients [(32.2%); n = 6 during first Holter-ECG, n = 13 during second/third Holter-ECG]. In all patients suffering from nsVT during follow-up previous Holter ECG revealed multiform/repetitive PVC. PVC burden was not linked to differences in systolic pulmonary arterial pressure, right atrial pressure, brain natriuretic peptide and results of six-minute walk test. Conclusion: Patients with PAC tend to have a shortened survival. None of the evaluated parameters (BNP, TAPSE, sPAP) was correlated with the development of arrhythmias. Patients with multiform/repetitive PVC seem to be at risk for ventricular arrhythmias.
RESUMO
The usage of high-strength steels for structural components and reinforcement parts is inevitable for modern car-body manufacture in reaching lightweight design as well as increasing passive safety. Depending on their microstructure these steels show differing damage mechanisms and various mechanical properties which cannot be classified comprehensively via classical uniaxial tensile testing. In this research, damage initiation, evolution and final material failure are characterized for commercially produced complex-phase (CP) and dual-phase (DP) steels in a strength range between 600 and 1000 MPa. Based on these investigations CP steels with their homogeneous microstructure are characterized as damage tolerant and hence less edge-crack sensitive than DP steels. As final fracture occurs after a combination of ductile damage evolution and local shear band localization in ferrite grains at a characteristic thickness strain, this strain measure is introduced as a new parameter for local formability. In terms of global formability DP steels display advantages because of their microstructural composition of soft ferrite matrix including hard martensite particles. Combining true uniform elongation as a measure for global formability with the true thickness strain at fracture for local formability the mechanical material response can be assessed on basis of uniaxial tensile testing incorporating all microstructural characteristics on a macroscopic scale. Based on these findings a new classification scheme for the recently developed high-strength multiphase steels with significantly better formability resulting of complex underlying microstructures is introduced. The scheme overcomes the steel designations using microstructural concepts, which provide no information about design and production properties.
