Revolutionizing Chronic Heart Disease Management: The Role of IoT-Based Ambulatory Blood Pressure Monitoring System.

Chronic heart disease (CHD) is a widespread and persistent health challenge that demands immediate attention. Early detection and accurate diagnosis are essential for effective treatment and management of this condition. To overcome this difficulty, we created a state-of-the-art IoT-Based Ambulatory Blood Pressure Monitoring System that provides real-time blood pressure readings, systolic, diastolic, and pulse rates at predefined intervals. This unique technology comes with a module that forecasts CHD's early warning score. Various machine learning algorithms employed comprise Naïve Bayes, K-Nearest Neighbors (K-NN), random forest, decision tree, and Support Vector Machine (SVM). Using Naïve Bayes, the proposed model has achieved an impressive 99.44% accuracy in predicting blood pressure, a vital aspect of real-time intensive care for CHD. This IoT-based ambulatory blood pressure monitoring (IABPM) system will provide some advancement in the field of healthcare. The system overcomes the limitations of earlier BP monitoring devices, significantly reduces healthcare costs, and efficiently detects irregularities in chronic heart diseases. By implementing this system, we can take a significant step forward in improving patient outcomes and reducing the global burden of CHD. The system's advanced features provide an accurate and reliable diagnosis that is essential for treating and managing CHD. Overall, this IoT-based ambulatory blood pressure monitoring system is an important tool for the early identification and treatment of CHD in the field of healthcare.

Echocardiographic Study of Ventricular Septal Defect in 1- to 12-Year-Old Children Visiting a Tertiary Care Center in Patna, India.

Background Symptoms of serious heart problems present at birth often appear during the first few days, weeks, or months of a child's life. Shunt formation between the left and right ventricle is a crucial component of the pathophysiology of ventral septal defects. Objectives We aim to determine the most frequent types of ventricular septal defect (VSD) by echocardiography and whether there is any gender variation in the type of ventricular septal defect. Material and methods A total of 100 children who were clinically suspected of or diagnosed with VSD at the age of 1-12 years were enrolled in this study. The septum of the atrioventricular (AV) canal, the muscular septum, and the parietal band of the distal conal septum were evaluated by color Doppler. Ventricular septal defect (VSD) size and kind are similarly impacted by the 2D echo mode. The size and site of the VSD, associated congenital anomaly, and significant morphological changes in ventricular cavities, gender discrimination, and relation-specific types of ventricular septal defect were observed. Results A total of 100 VSD children presented with clinical symptoms of fast breathing, retraction of the chest, cough, cyanosis, fever, difficulty during feeding, cyanotic spell, chest pain, and edema at 65%, 62%, 54%, 52%, 54%, 29%, 9%, 11%, and 4%, respectively. Conclusion Early diagnosis is essential for effective medical care of diseases such as infective endocarditis (IE), which is present in some cases of VSD, and the avoidance of persistent pulmonary veno-occlusive disease (PVOD).

Pneumococcal Pure Polysaccharide Vaccination in Pediatric Patients With Chronic Heart Disease.

INTRODUCTION: This study aimed to describe pneumococcal polysaccharide vaccine-23 (PPSV23) vaccination use in high-risk pediatric patients with chronic heart disease (CHD). METHOD: This was a single-center retrospective cohort study. Patients were included if they were aged 2-18 years and were diagnosed with CHD. The primary outcome was PPSV23 vaccination. Secondary outcomes included missed opportunities and the incidence of infections. RESULTS: Three hundred ninety-two patients were included; the mean age was 8.8 years. Only 40 patients (10.2%) had documentation of PPSV23 vaccination. Patients had a median number of three clinic visits in 2019. There were 114 cases of pneumonia documented in patients before receiving PPSV23 and one case reported after PPSV23 vaccination. DISCUSSION: PPSV23 vaccination in high-risk pediatric patients with CHD was low, with many documented missed opportunities for vaccination. This may be attributed to the PPSV23 not being a routine vaccination on the pediatric schedule.

Subclinical Atrial Fibrillation on Prolonged ECG Holter Monitoring: Results from the Multicenter Real-World SAFARI (Silent Atrial Fibrillation ANCE-Sicily Research Initiative) Study.

BACKGROUND: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower in the general population. The prospective, multicentric, observational Silent Atrial Fibrillation ANCE Research Initiative (SAFARI) study aimed at assessing the SAF prevalence in a real-world outpatient setting by the means of a small, wearable, prolonged ECG Holter monitoring (>5 days) device (CGM HI 3-Lead ECG; CGM TELEMEDICINE, Piacenza, Italy). METHODS: Patients ≥ 55 years of age at risk for AF were screened according to the inclusion criteria to undergo prolonged 3-lead ECG Holter monitoring. SAF episodes were classified as follows: Class A, <30 s; Class B, 30 to 299 s; and Class C, ≥300 s. RESULTS: In total, 119 patients were enrolled (64 men; median age 71 (IQR 55-85) years). At a median of 13.5 (IQR 5-21) days of monitoring, SAF episodes were found in 19 patients (16%). A total of 10,552 arrhythmic episodes were registered, 6901 in Class A (n = 7 patients), 2927 in Class B (n = 3), and 724 in Class C (n = 9), (Class A vs. B and C, p < 0.001). This latter group had multiple (all-class) episodes, and two patients had >1000 episodes. There were no clinical, echocardiographic, or laboratory findings able to discriminate patients with SAF from those in sinus rhythm in univariate and multivariable analyses; of note is that the Class C patients showed a higher diastolic blood pressure, resting heart rate, and indexed LA volume. CONCLUSIONS: Over a median of 13 days of Holter monitoring, the SAFARI study confirmed the usefulness of small wearable devices in detecting SAF episodes in real-world outpatients at risk for, but with no prior history of, AF.

Pharmacological effects and mechanisms of YiYiFuZi powder in chronic heart disease revealed by metabolomics and network pharmacology.

Introduction: YiYiFuZi powder (YYFZ) is a classical formula in Chinese medicine, which is commonly used clinically for the treatment of Chronic Heart Disease (CHD), but it's pharmacological effects and mechanism of action are currently unclear. Methods: An adriamycin-induced CHD model rat was established to evaluate the pharmacological effects of YYFZ on CHD by the results of inflammatory factor level, histopathology and echocardiography. Metabolomic studies were performed on rat plasma using UPLC-Q-TOF/MS to screen biomarkers and enrich metabolic pathways; network pharmacology analysis was also performed to obtain the potential targets and pathways of YYFZ for the treatment of CHD. Results: The results showed that YYFZ significantly reduced the levels of TNF-α and BNP in the serum of rats, alleviated the disorder of cardiomyocyte arrangement and inflammatory cell infiltration, and improved the cardiac function of rats with CHD. The metabolomic analysis identified a total of 19 metabolites, related to amino acid metabolism, fatty acid metabolism, and other metabolic pathways. Network pharmacology showed that YYFZ acts through PI3K/Akt signaling pathway, MAPK signaling pathway and Ras signaling pathway. Discussion: YYFZ treatment of CHD modulates blood metabolic pattern and several protein phosphorylation cascades but importance specific changes for therapeutic effect require further studies.

Chagas disease mortality during the coronavirus disease 2019 pandemic: A Brazilian referral center experience

ABSTRACT Background We investigated the mortality rates of patients with Chagas disease (CD) during the coronavirus disease 2019 (COVID-19) pandemic and assessed the association between this mortality and CD clinical presentation and comorbidities. Methods: This was an observational retrospective study with clinical data retrieved from medical records. Results: Comorbidities were more prevalent among patients who died from COVID-19 than those who died from other causes. The proportion of patients according to CD clinical presentation was similar between the two groups. Conclusions: The prevalence of comorbidities seems to be related to a poorer prognosis in CD and COVID-19.

COVID-19 Patient with Severe Comorbidity in Multimodal Acute Care Setting with Non-Invasive Medical Ventilation: A Clinical Outcome Report.

The virus that causes COVID-19 is rapidly spreading across the globe. Elderly patients with multiple pre-existing conditions are at a higher risk. This case study describes acute inpatient treatment of a COVID-19 patient with uncontrolled diabetes mellitus, kidney complications, heart failure, chronic pain, depression, and other comorbidities in an isolation ward without mechanical ventilation.

Influenza coverage rates in subjects with chronic heart diseases: results obtained in four consecutive immunisation seasons in the Local Health Unit of Ferrara (North Italy)".

BACKGROUND: Seasonal influenza epidemics yearly affects 5-15% of the world's population, resulting in 3-5 million serious cases and up to 650,000 deaths. According to the 2017-2019 Italian National Immunisation Plan, free immunisation is offered to the categories at increased risk of experience the complications of the infection (over 65 years old subjects, pregnant women and individuals with underlying conditions, including chronic heart diseases). Rising evidence suggests that influenza can trigger adverse cardiovascular events therefore the vaccination is recommended for secondary prevention of cardiovascular diseases. Despite this, the influenza coverage rate in subjects with chronic heart disease is underestimated. METHODS: The study investigated the coverage rate in four consecutive influenza seasons (from 2011/2012 to 2014/2015) in subjects that benefit from exemption from paying healthcare costs for chronic heart disease living in Local Health Unit (LHU) of Ferrara (Italy), comparing the databases of exemptions and immunisations. RESULTS: The levels of influenza vaccine uptake were unstable, reaching the 50.3% in 2011/2012 immunisation season and falling to 42.2% in the following year. Coverage rates increased with increasing age, without achieving the 75% target, neither in over 65 years old subjects. The logistic regression analysis showed that influenza coverage rates were statistically significant different (p < 0.0001, 0.003 only for category of disease in 2011/2012 immunisation season) according to age, district of residence, category of chronic heart disease and length of exemption, but not influenced by gender. CONCLUSIONS: The recommendation of influenza immunisation was weakly followed in individuals with chronic heart diseases. A collaboration between cardiologists, GPs, scientific societies and patient associations could successfully support influenza vaccine uptake.

The Electrocardiogram: Still a Useful Tool in the Primary Care Office.

A 12-lead electrocardiogram (ECG) is the most commonly ordered cardiac test. Although data are not robust, guidelines recommend against performing an ECG in patients who are asymptomatic, even if they have a higher risk of developing cardiovascular disease in the long term. Conversely, patients with cardiac symptoms, including chest pain, dyspnea, palpitation, and syncope, should have an ECG performed in the office. Computerized algorithms exist ubiquitously to guide interpretation, but they can be the source of erroneous information. A stepwise approach is given to guide the primary care physician's approach to the systematic interpretation of ECG tracings.

Determination of the Th1, Th2, Th17, and Treg cytokine profile in patients with chronic Chagas heart disease and systemic arterial hypertension.

Chronic Chagas heart disease (CCHD affects about 30% of patients with chronic Chagas disease (CCD). Systemic arterial hypertension (SAH) afflicts about 25% of patients with CCD. The association of CCHD with SAH (CCHD-SAH) predisposes patients to develop chronic heart failure. The role of cytokines in disease progression in patients with CCHD-SAH is unknown. Accordingly, the aim of this study was to evaluate the plasma levels of cytokines expressing the Th1, Th2, Th17 pattern, as well as Treg cytokines, TNF-alpha, IL-1ß, IL-8, IL-7 in patients with SAH-CCHD to get insight into the immunomodulation process in patients with this condition. Fifteen patients with CCHD, 22 patients with CCHD-SAH, and 28 controls were studied. All patients underwent history-taking, physical examination, 12-lead resting ECG, chest X-ray, and Doppler-echocardiogram. Ten of 15 (66%) patients with CCHD, and 16 of 22 (73%) patients with CCHD-SAH had decreased left ventricular ejection fraction (p > 0.05). Cytokines levels were performed on plasma samples using the ELISA method. Overall, proinflammatory, anti-inflammatory, and regulatory cytokine levels were increased in patients with CCHD-SAH in comparison to patients with CCHD and controls. However, such a difference was higher regarding IL-2, IL-5, IL-17, IL-12, and TNF-alpha cytokine levels, respectively. Cytokine levels were higher in CCHD patients in comparison to controls. Patients with CCHD-SAH have increased plasma levels of pro-inflammatory, anti-inflammatory, and regulatory cytokines in comparison with CCHD patients, thus suggesting a higher level of immunomodulation in patients with CCHD-SAH.

Coexistence of obstructive sleep apnea worsens the overall outcome of intracranial aneurysm: a pioneer study.

OBJECTIVE Obstructive sleep apnea (OSA) is associated with the progression of abdominal and thoracic aortic aneurysms. However, the role of OSA in the overall outcome of intracranial aneurysms (IAs) has not yet been established. Authors of this report investigated the role of OSA in the overall outcome of IAs. METHODS Radiological and clinical data on patients (from 2010 through 2015) with confirmed IA were retrospectively reviewed. Significant differences between the OSA and non-OSA groups were determined using a chi-square test. Logistic regression analysis was performed to identify the predictors of an unfavorable IA outcome. RESULTS Among the 283 patients with confirmed IAs, 45 patients (16%) were positively screened for OSA, a proportion that was significantly higher than the prevalence of OSA in nonaneurysmal neurosurgical patients (4%, p = 0.008). The percentage of patients with hypertension (p = 0.018), a body mass index ≥ 30 kg/m2 (p < 0.0001), hyperlipidemia (p = 0.034), diabetes mellitus (p = 0.005), chronic heart disease (CHD; p = 0.024), or prior stroke (p = 0.03) was significantly higher in the OSA group than in the non-OSA group. Similarly, the percentage of wide-necked aneurysms (p = 0.00001) and patients with a poor Hunt and Hess Grade IV-V (p = 0.01) was significantly higher in the OSA group than in the non-OSA group. In addition, the percentage of ruptured aneurysms (p = 0.03) and vasospasms (p = 0.03) was significantly higher in the OSA group. The percentage of patients with poor modified Rankin Scale (mRS) scores (3-6) was significantly higher in the OSA group (p = 0.03). A separate cohort of patients with ruptured IAs showed similar results. In both univariate (p = 0.01) and multivariate (p = 0.04) regression analyses, OSA was identified as an individual predictor of an unfavorable outcome. In addition, hypertension and prior stroke were revealed as predictors of a poor IA outcome. CONCLUSIONS Complications of IA such as rupture and vasospasm are often the consequence of uncontrolled OSA. Overall outcome (mRS) of IAs is also affected by the co-occurrence of OSA. Therefore, the coexistence of OSA with IA affects the outcome of IAs. Obstructive sleep apnea is a risk factor for a poor outcome in IA patients.

A comprehensive analysis of association of medical history with airflow limitation: a cross-sectional study.

BACKGROUND: Multiple comorbidity is common and increases the complexity of the presentation of patients with COPD. This study was a comprehensive analysis of the relationship between a medical history of 22 disease categories and the presence of airflow limitation (AL) without any history of asthma or bronchiectasis, compatible with COPD. METHODS: A total of 11,898 Japanese patients aged ≥40 years, who underwent spirometry tests, comprising patients with AL (n=2,309) or without AL (n=9,589), were evaluated. Generalized estimating equations were used to assess the relationship between the presence of AL and each disease. The model was adjusted for age, sex, body mass index (BMI) and pack-years of smoking. RESULTS: In multivariate analysis, female sex (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.52-0.67), age (OR for 10-year age increase: 1.99; CI: 1.90-2.09), BMI (OR for 1 kg/m2 increase: 0.96; CI: 0.95-0.98) and smoking history (<15 vs 15-24, 25-49 and ≥50 pack-years; OR: 1.78, 2.6 and 3.69, respectively; CI: 1.46-2.17, 2.24-3.0 and 3.15-4.33, respectively) were significantly associated with the presence of AL. In addition, a history of tuberculosis (OR: 1.72; CI: 1.39-2.11), primary lung cancer (OR: 1.50; CI: 1.28-1.77), myocardial infarction (OR: 1.22; CI: 1.01-1.48), heart failure (OR: 1.53; CI: 1.29-1.81), arrhythmia (OR: 1.19; CI: 1.03-1.38) or heart valve disorder (OR: 1.33; CI: 1.14-1.56) was significantly associated with the presence of AL, after adjustment. CONCLUSION: This study suggests that a history of heart disease leading to abnormal cardiac function may be associated with AL and that the presence of certain types of heart disease provides a rationale to assess lung status and look for respiratory impairment, including COPD.

Association of Flavin Monooxygenase Gene E158K Polymorphism with Chronic Heart Disease Risk.

We studied the relationship between the risk of chronic heart disease and FMO3 gene polymorphism E158K analyzed by PCR and restriction fragment length polymorphism (RFLP) analysis. The homozygous 158KK genotype of FMO3 gene is associated with high risk of chronic heart disease in women, but not in men. FMO3 gene polymorphism E158K is a significant predictor of predisposition to chronic heart disease in women.

Bone Marrow Therapies for Chronic Heart Disease.

Chronic heart failure is a leading cause of death. The demand for new therapies and the potential regenerative capacity of bone marrow-derived cells has led to numerous clinical trials. We critically discuss current knowledge of the biology and clinical application of bone marrow cells. It appears unlikely that bone marrow cells can develop into functional cardiomyocyte after infusion but may have favorable paracrine effects. Most, but not all, clinical trials report a modest short- but not long-term benefit of infusing bone marrow-derived cells. Effect size appears to correlate with stringency of study-design: the most stringent trials report the smallest effect-sizes. We conclude there may be short- but not substantial long-term benefit of infusing bone marrow-derived cells into persons with chronic heart failure and any benefit observed is unlikely to result from trans-differentiation of bone marrow-derived cells into functioning cardiomyocytes.

EFFECT OF HOME-BASED NON-INSTRUMENTAL RESISTANCE TRAINING ON EXERCISE CAPACITY OF PATIENTS WITH CHRONIC HEART DISEASE / 体力科学

<b>Purpose:</b> The purpose of this study was to investigate the effect of non-instrumental resistance training on exercise capacity of patients with chronic heart disease. <b>Methods:</b> Nineteen elderly male patients (66.2±5.7 years) participated in the study. All had experienced coronary artery bypass surgery, coronary artery intervention, or aortic valve replacement [left ventricular ejection fraction (EF): 54.0±15.8 %]. Patients were divided into two groups. T group (N=9) performed combined aerobic and non-instrumental resistance training; and C group (N=10) performed only aerobic exercise. Resistance training involved 10 to 15 repetitions (maximum)(RM) of squats, push ups, calf raises and trunk curls. Each exercise included 3 sets of 10 repetitions repeated 3 times a week. Aerobic exercise was prescribed at the intensity of the aerobic threshold (AT) level 3 times a week. There was no significant base line for either T group or C group. <b>Results:</b> After three months of exercise, peak torque, peak VO₂, and peak watts were significantly greater in T group, compared to those of C group. However, there was no significant correlation (r = .49) between the improvement of peak VO₂ and peak torque. <b>Conclusion:</b> It was concluded that combined aerobic and non-instrumental resistance training is more effective than aerobic exercise alone for exercise capacity of patients with chronic heart disease. Home-based non-instrumental resistance training is usually highly significant from the perspective of the exercise capacity of patients with chronic heart disease.

The change of heart rate variability time in patients with chronic heart failure

Background: Heart failure is a common clinical condition and is the late stage of most cardiovascular diseases. Heart rate disorder is one of the causes of deaths in patients with chronic heart failure. There is few number of studies on Heart Rate Variability (HRV) in Vietnam. Objective: To study the change of HRV time in patients with chronic heart failure. Subject and Method: A prospective, descriptive and cross-sectional study was carried out on 105 subjects including 73 patients with chronic heart failure and 42 normal persons as controls. Time domain measurements of HRV were calculated from 24 hour electrocardiographic Holter (Holter WIN P-V, USA) on all 105 subjects. In the chronic heart failure group, there were 51 men and 22 women with the mean age of 62.8+/-11.2, control group including 30 men and 12 women with the mean age of 61.5+/-5.7. Results and conclusion: (1) There was a decrease of time domain of HRV showed the decrease of parasympathetic tone in patients with chronic heart diseases. (2) The higher degree of heart failure, the lower the time domain of HRV.