Marta Rigoni

Heart Rate Turbulence Is a Powerful Predictor of Cardiac Death and Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure Patients: A Systematic Review and Meta-Analysis

Background—Heart rate turbulence (HRT) has been proposed as a candidate marker of altered autonomic tone, and some studies showed its prognostic value for both cardiac death (CD) and sudden death. Nevertheless, HRT is not currently used in the clinical practice. Methods and Results—We performed a systematic review and meta-analysis of the predictive value of HRT for the end points of total mortality, CD, and fatal and nonfatal ventricular arrhythmias in postacute myocardial infarction and heart failure patients. MEDLINE and The Cochrane Library databases were systematically searched to identify studies, which analyzed the predictive value of abnormal HRT for the defined end points. Twenty studies (25 cohorts: 12 832 patients) were identified by the systematic review, and 15 studies (20 cohorts: 11 499 patients) were included in the meta-analyses. Abnormal HRT was a predictive marker for all the end points in heart failure patients and more markedly in postacute myocardial infarction patients, where 9 out of the 10 cohorts had an ejection fraction >30%. In postacute myocardial infarction patients, HRT had pooled risk ratios of 3.53 (95% confidence interval [CI], 2.54–4.90), 4.82 (95% CI, 3.12–7.45), and 4.48 (95% CI, 3.04–6.60), and positive likelihood ratios of 3.5 (95% CI, 2.6–4.8), 4.1 (95% CI, 3.0–5.7), and 2.7 (95% CI, 2.2–3.3) for total mortality, CD, and arrhythmic events, respectively. The combination of abnormal HRT and T-wave alternans (5 cohorts: 1516 patients) increased the predictive power for CD and arrhythmic events. Conclusions—HRT is a powerful predictor of both CD and arrhythmic events, particularly in postacute myocardial infarction patients with ejection fraction >30%. HRT power increases in combination with T-wave alternans analysis.

Application of the National Early Warning Score (NEWS) as a stratification tool on admission in an Italian acute medical ward: A perspective study

We aimed to assess the performance of the National Early Warning Score (NEWS) as tool for patient risk stratification at admission in an acute Internal Medicine ward and to ensure patient placement in ward areas with the required and most appropriate intensity of care. As secondary objective, we considered NEWS performance in two subgroups of patients: sudden cardiac events (acute coronary syndromes and arrhythmic events), and chronic respiratory insufficiency.

ATP Measurement in the Last Rinse Water of Automated Washer-Disinfectors:The Added Value of Every Load Monitoring

Objective: To assess whether monitoring every loads of automated washer-disinfectors (AWDs) by testing the last rinse water with Adenosine Triphosphate (ATP) would have an added value to document effective and reproducible AWD processes. Methods: Every load monitoring (ELM) of the last rinse water with ATP was performed on three AWDs at the sterilization department of a 329 acute-bed hospital in Italy. No change were made in the routine procedures, except the last rinse water of a process was collected with a water sampler and tested on ATP. Data from negative controls and empty cycles were also obtained for comparison. ATP values were analysed according to AWD, load, and process characteristics. Results: A total of 435 ATP tests were performed, including 74 negative, 74 empty runs and 287 regular load tests. ATP values from regular loads ranged between 2 and 452 RLUs and 1.3%, 0.7%, 0.3% out of the 287 measurements was above 200, 300, and 400 RLUs, respectively. ATP values from negative tests and empty runs differed significantly (p<0.001) from the regular loads with a median value [I quartile; III quartile] of 4[2;5], 5[3;7], and 12[7;22] RLU, respectively. Analysis of ATP values from regular loads grouped by load pre-treatment, AWD washing program, load material or load amount showed significant differences between groups. No significant differences in ATP data were found among AWDs. Conclusion: The measurement of ATP in the last rinse water of AWDs showed that characteristics and quantities of the load relate to the ATP readings. The test is advised as an informative additional test to visual inspection for monitoring every load of an AWD.

Implantable Cardioverter-Defibrillator in Dilated Cardiomyopathy after the DANISH-Trial Lesson. A Poly-Parametric Risk Evaluation Is Needed to Improve the Selection of Patients

Citation: Disertori M, Masè M, Rigoni M, Nollo G, Arbustini E and Ravelli F (2017) Implantable Cardioverter-Defibrillator in Dilated Cardiomyopathy after the DANISH-Trial Lesson. A Poly-Parametric Risk Evaluation Is Needed to Improve the Selection of Patients. Front. Physiol. 8:873. doi: 10.3389/fphys.2017.00873 Implantable Cardioverter-Defibrillator in Dilated Cardiomyopathy after the DANISH-Trial Lesson. A Poly-Parametric Risk Evaluation Is Needed to Improve the Selection of Patients

Ventricular tachycardia-inducibility predicts arrhythmic events in post-myocardial infarction patients with low ejection fraction. A systematic review and meta-analysis

Background Inducibility of ventricular arrhythmias at electrophysiological study (EPS) has long been suggested as predictive for subsequent arrhythmic events. Nevertheless, the usefulness of EPS in the clinical practice is still unclear. We performed a systematic review and meta-analysis to assess the predictive power of EPS in primary prevention of ventricular arrhythmias in post-myocardial infarction (MI) patients with left ventricular dysfunction. Methods MEDLINE and the Cochrane Library databases were systematically searched to identify studies, which analyzed EPS predictive value in post-MI patients with mean EF < 40% for the composite arrhythmic endpoint defined by: sudden cardiac death (SCD), aborted SCD, ventricular tachycardia (VT), ventricular fibrillation (VF), appropriate implantable cardioverter-defibrillator (ICD) interventions. Results Nine studies, evaluating 3959 patients with 647 arrhythmic events, were included in the meta-analyses. EPS showed a strong predictive power for the arrhythmic endpoint with a pooled odds ratio (OR) of 4.00 (95% confidence interval [CI]: 2.30–6.96) in the whole set of studies, albeit a high level of heterogeneity among studies. EPS predictive power was higher in studies where VT-inducibility was tested (OR 6.52; 95% CI: 2.30–18.44; sensitivity 0.65, specificity 0.78, and negative predictive value 0.94), versus those assessing VT/VF-inducibility (OR 2.09; 95% CI: 1.34–3.26). VT-inducibility was predictive even when assessed within one month after MI (OR 7.85; 95% CI: 3.67–16.80). Conclusions Inducibility of ventricular arrhythmias at EPS is a strong predictor of the arrhythmic endpoint in post-MI patients with impaired EF, particularly when VT-inducibility is tested. EPS could help selecting the patients who can mostly benefit from ICD therapy.

A Multi-techniques Approach to assess reprocessing of Single-use electrosurgical pencils.

Reprocessing and reuse of single-use electrosurgical pencils (EPs) is a diffused practice in countries with limited access to healthcare subvention system and in developing countries. However, safety and efficacy issues are associated to this practice, requiring specific methods for checking the reprocessed device before clinical re-use. This study aimed at defining a set of testing methods for assessing thermal and surface characteristics of reprocessed single-use EPs and evaluating the suitability of these techniques for revealing modifications between brand new and reprocessed single-use EPs. We reported a multi-technique approach based on optical and electron microscopy, X-rays spectroscopy and thermal analysis. The assessment of a total of 30 variables of interest on both brand new and reprocessed devices, allowed to identify the most informative ones. Seven of the evaluated variables were found to differentiate the reprocessed device from the new ones in a significant way. The presented methods deserve potential for tracking modifications during the device lifecycle.

Assessing Composition of Coronary Thrombus in STEMI Patients - A Multiscale Approach to Charaterize Samples Obtained by Catheter Aspiration

Percutaneous catheter thrombectomy allows collecting coronary thrombi from patients with ST-segment elevation myocardial infarction, preserving most of the sample characteristics available for both visual assessment and compositional analysis. This study aimed at identifying the association between thrombus macroscopic aspect and composition and, secondly, correlations between composition and ischemic time. Aspirated thrombi were grouped into “white”, “red” or “mixed” according to their macroscopic appearance. Platelets, RBCs and fibrin were quantified on thrombus surface by SEM and on thrombus sections by a modified Carstairs histochemical staining. Fifty-three samples from 51 patients were included. The median [inter-quartile range] ischemic time was 210 [190-265] min. Seven (13%) “white”, 19(36%) “mixed” and 27(51%) “red” thrombi were macroscopically identified. Median thrombus composition assessed by SEM was 23[11-41]%, 43[26-62]%, and 24[11-37]% for platelets, RBCs and fibrin respectively. Median histological analysis was 10[5-26]%, 45[31-64]% and 30[18-49]% for the same components. Significant difference in composition were found between “white” and “red” thrombi, showing respectively a higher amount of platelets (p=0.003) and fibrin (p=0.007). No significant correlations were found between composition and ischemic time suggesting that plaque instability and thrombus formation can occur before