Giedrė Bakšytė

Prognosis of in-hospital myocardial infarction course for diabetic and nondiabetic patients using a noninvasive evaluation of hemodynamics and heart rate variability.

BACKGROUND AND OBJECTIVE The objective of our study was to investigate whether the combination of markers of heart rate variability (HRV) and impedance cardiography (ICG) help evaluate the risk of in-hospital death, ventricular arrhythmia, or complicated course secondary to myocardial infarction (STEMI) and to clarify whether combined analysis of HRV and ICG improve prognosis of STEMI, comparing 3 groups: 1) diabetic, 2) nondiabetic, and 3) diabetes-unselected patients. MATERIAL AND METHODS The parameters reflecting heart rate variability and central hemodynamics were estimated from a 24-hour synchronic electrocardiogram and thoracic impedance signal recordings in 232 patients (67 diabetic) on the third day after myocardial infarction. Logistic regression analysis was used to determine the predictors of selected outcomes. Different prognostic models were compared with the receiver operating characteristic curve analysis. RESULTS The model consisting of low- and high-frequency power ratio (LF/HF) and cardiac output (CO) was elaborated for the prognosis of in-hospital death in the group 3 (odds ratios [ORs] were 9.74 and 4.85, respectively). Very low-frequency power (VLF), cardiac index (CIN), and cardiac power output (CPO) were the predictors of ventricular arrhythmia in the group 2 (ORs of 1.005, 5.09, and 66.7, respectively) and the group 3 (ORs of 1.004, 3.84, and 37.04, respectively). The predictors of the complicated in-hospital course in the group 1 were the baseline width of the minimum square difference triangular interpolation of the highest peak of the histogram of all NN intervals (TINN) and stroke volume (SV) (ORs of 1.006, and 1.009, respectively); in the group 2, the mean of the standard deviations of all NN intervals for all 5-minute segments of the recording (SDNN index) and CPO (ORs of 1.06 and 2.44, respectively); and in the group 3, SDNN index, VLF, LF/HF, CIN (ORs of 1.04, 1.004, 2.3, and 3.49, respectively). CONCLUSIONS The patients with decreased HRV and low estimates of central hemodynamics evaluated by ICG are at an increased risk of the adverse in-hospital course of STEMI. The combined analysis of HRV and ICG hemodynamic estimates contributes to the risk assessment of the complicated in-hospital course of STEMI, in-hospital hemodynamically significant ventricular arrhythmia, and in-hospital death secondary to STEMI. The in-hospital prognostic value of the combined estimates of HRV and ICG is lower in the STEMI patients with diabetes mellitus as compared with the nondiabetic patients.

Applicability of Impedance Cardiography During Heart Failure Flare-Ups

Background Heart failure (HF) accounts for about 5% of all causes of urgent hospital admissions, and the overall mortality of HF patients within 1 year after hospitalization is 17–45%. Transthoracic impedance cardiography (ICG) is a safe, non-invasive diagnostic technique that helps to detect various parameters that define different cardiac functions. The aim of this study was to investigate the value of ICG parameters in patients hospitalized due to HF flare-ups. Material/Methods The study included 60 patients (24 women and 36 men) who were admitted to intensive care units because of an acute episode of HF without signs of myocardial infarction. The diagnosis of HF as the main reason for hospitalization was verified according to the universally accepted techniques. ICG data were compared to those obtained via other HF diagnostic techniques. Results A moderately strong relationship was found between the ejection fraction (EF) and the systolic time ratio (STR) r=−0.4 (p=0.002). Findings for STR and thoracic fluid content index (TFCI) differed after dividing the subjects into groups according to the EF (p<0.05). A moderately strong relationship was found between brain natriuretic peptide and TFCI r=0.425 (p=0.001), left cardiac work index (LCWI) r=−0.414 (p=0.001). Findings for TFCI, LCWI, and cardiac output differed after dividing the subjects into groups according to HF NYHA classes (p<0.05). Conclusions Transthoracic impedance cardiography parameters could be applied for the diagnostics and monitoring of HF, but further studies are required to evaluate the associations between ICG findings and HF.

Detection and evaluation of ventricular repolarization alternans: an approach to combined ECG, thoracic impedance, and beat-to-beat heart rate variability analysis.

BACKGROUND AND OBJECTIVE Beat-to-beat alteration in ventricles repolarization reflected by alternans of amplitude and/or shape of ECG S-T,T segment (TWA) is known as phenomena related with risk of severe arrhythmias leading to sudden cardiac death. Technical difficulties have caused limited its usage in clinical diagnostics. Possibilities to register and analyze multimodal signals reflecting heart activity inspired search for new technical solutions. First objective of this study was to test whether thoracic impedance signal and beat-to-beat heart rate reflect repolarization alternans detected as TWA. The second objective was revelation of multimodal signal features more comprehensively representing the phenomena and increasing its prognostic usefulness. MATERIALS AND METHODS ECG, and thoracic impedance signal recordings made during 24h follow-up of the patients hospitalized in acute phase of myocardial infarction were used for investigation. Signal morphology variations reflecting estimates were obtained by the principal component analysis-based method. Clinical outcomes of patients (survival and/or rehospitalization in 6 and 12 months) were compared to repolarization alternans and heart rate variability estimates. RESULTS Repolarization alternans detected as TWA was also reflected in estimates of thoracic impedance signal shape and variation in beat-to-beat heart rate. All these parameters showed correlation with clinical outcomes of patients. The strongest significant correlation showed magnitude of alternans in estimates of thoracic impedance signal shape. CONCLUSIONS The features of ECG, thoracic impedance signal and beat-to-beat variability of heart rate, give comprehensive estimates of repolarization alternans, which correlate, with clinical outcomes of the patients and we recommend using them to improve diagnostic reliability.

Focus Assessed Echocardiography Performed By Inexperienced Examiners In A Cardiac Intensive Care Unit / Fok Spe Kusētā Ehokardiogrāfija, Ko Sirds Ķirurģijas Intensīvās Terapijas Nodaļā Veic Nepieredzējuši Ciālisti

Abstract Focus assessed echocardiography (FATE) provides an excellent possibility to evaluate basic haemodynamic determinants, such as preload, afterload, contractility, compliance and relaxation, by observing obvious pathology, assessing wall thickness and chamber dimensions, biventricular function, and pleura, and relating the acquired information to the clinical situation. The goal of this study was to evaluate the applicability of FATE protocol in cardiac ICU when it was performed by inexperienced examiner. A total of 101 patients with acute myocardial infarction (AMI) were enrolled in the study. All AMI subjects were examined by two examiners with no previous experience in ultrasound using standard FATE protocol with addition of inferior vena cava (IVC) and aortic views. Data collected by inexperienced examiners was compared with the data from echocardiography performed by a cardiologist. We acquired a mean number of 5.75 ± 1.2 informative echo windows for each patient of 7 used in protocol. Mean number of informative echo windows acquired for one patient was greater in the non-smoker compared to no respiratory disease patient group (6.0 ± 1.2 vs 5.3 ± 1.8; p = 0.032). Quantitative echo measurements from inexperienced examiners correlated with measurements conducted by a cardiologist: LVEDD (R = 0.74; p < 0.01); IVSd (R = 0.71; p < 0.01); LVPWd (R = 0.61; p < 0.01). Substantial inter-observer agreement was observed for evaluation of diastolic function (K = 0.68; p < 0.01) and presence of pleural effusion (K = 0.76; p < 0.01). Abstract Fokusētā ehokardiogrāfija (EhoKG) ir lieliska metode, lai izvērtētu galvenos hemodinamikas rādītājus: sirds priekšslodzi, pēcslodzi, mio- karda kontrakti litāti, tā spēju iestiepties un atslābt, miokarda sieniņas biezumu, sirds kambaru izmērus un funkciju, kā ari novērtēt pleiras telpu, iegūto informāciju piemērojot konkrētai klīniskai situācijai. Pētījuma mērķis bija novērtēt fokusētās EhoKG iegūtos datus, to veicot nepieredzējušam speciālistam sirds ķirurģijas intensīvās terapijas nodaļā. Pētījumā iekļauts 101 pacients ar akūtu miokarda infarktu, kuriem divi speciālisti bez iepriekšējas pieredzes ultrasonogrāfijas izmeklēšanā veica fokusēto EhoKG pēc standarta protokola, papildus izmantojot apakšējās dobās vēnas un aortālos skatu logus. Iegūtie dati tika salīdzināti ar profesionāla ehokardiogrāfista fokusētās EhoKG izvērtējumu. Katram pacientam tika iegūti 5,75 ± 1,2 informatīvi EhoKG skatu logi no iespējamiem septiņiem. Tos labāk izdevās redzēt nesmēķētājiem un pacientiem bez respiratora trakta saslimšanām (6.0 ± 1,2 vs 5,3 ± 1,8; p = 0,032). Kvantitatīvie EhoKG mērījumi, kurus veica nepieredzējis ITN speciālists, korelēja ar tiem, kurus veicis pieredzējis EhoKG kardiologs: kreisā kambara beigu diastoliskais diametrs LVEDD (R = 0,74; p < 0,01); starpkambaru defekts IVSd (R = 0J\\p < 0,01); kreisā kambara mugurējās sienas izmērs LVPVVd (R = 0,61; p < 0,01). Līdzīgi dati tika iegūti arī, izvērtējot diastolisko funkciju (K = 0,68; p < 0,01) un šķidrumu pleiras telpā (K= 0,76; p < 0,01).

Overdose of Antiarrhytmic Drugs: Efective Medical Assistance

Overdose with antiarrhytmic drugs is very dangerous. Supportive measures are often required during the treatment of intoxication. Antiarrhythmics are known to have significant side effects and these especially include profound hypotension, vasodilation, negative inotropic effects, bradycardia. Although different classification schemes have been proposed, the first scheme (Vaughan-Williams) is still the one that most physicians use when speaking of antiarrhytmic drugs. Management of intoxication with antiarrhytmic agents includes gut decontamination with provision of respiratory support and treatment of cardiovascular system as needed. Hypertonic sodium bicarbonate, by antagonising the inhibitory effect on sodium conductance, may reverse many or all manifestations of cardiovascular toxicity. Glucagon, insulin infusion should be considered in patiens with moderate to severe calcium channel blocker and betaadrenoblocers overdose. Supportive care including the use of phosphodiesterase inhibitors, adrenergic agents, cardiac pacing, balloon pump or extracorporeal circulation is frequently indicated if antidotal therapy is not effective. Intravenous fat emulsion decreases cardiotoxity from several lipid-soluble drugs, including verapamil. Calcium salts may be given to overcome negative inotropic effects, impaired atrioventricular (AV) conduction. Hemodialysis sometimes is useful in case of sotalol overdose. Article in Lithuanian doi:10.5200/sm-hs.2012.115

New Sepsis Biomarker – Presepsin. Its Benefits and Future

Ankstyva sepsio diagnozė yra kritiskai svarbi sėkmingam sepsio gydymui. Ne mažiau svarbu nustatyti sepsio prognoze bei sekti gydymo efektyvumą. Pastaraisiais metais pastebėtas sepsio atvejų augimas, todėl svarbu surasti patikimą ir greitai nustatomą žymenį sepsio diagnostikai ir prognozei vertinti. Sioje apžvalgoje siekta aptarti naująjį sepsio žymenį – presepsiną ir palyginti jį su kitais populiariaisiais diagnostiniais sepsio rodikliais (prokalcitoninu, C-reaktyviu baltymu ir interleukinu 6) pagal specifiskumą, jautrumą ir prognozine verte. Isvados – tyrimų apžvalga parodė, kad didžiausią diagnostine ir prognozine verte pacientų isgyvenamumui turi presepsinas, lyginant su kitais žymenimis, siuo metu naudojamais sepsio diagnostikoje. Norint įsitikinti akivaizdžiu presepsino pranasumu, reikėtų atlikti daugiau klinikinių tyrimų, taciau jau dabar galime teigti, kad sis žymuo klinikinėje praktikoje yra pakankamai patikimas prognozinis sepsio rodiklis. doi:10.5200/sm-hs.2012.072