LIVE/DEAD YEAST VIABILITY STAINING AS A TOOL FOR IMPROVING ARTISANAL PILSNER BEER PRODUCTION

The production of an artisanal beer, made by brewers using traditional practices on a small scale, is founded on the empirical adjustment of parameters, including yeasts handling and serial repitching. The aim of this study was to monitor yeast viability during different stages of artisanal beer productions through the Live/Dead Yeast viability staining and to correlate it with fermentation dynamics in order to increase process standardization and to maintain the quality of final products. Yeast viability and fermentation activities were evaluated during seven fermentation cycles of an artisanal pilsner beer. Yeast inoculated with higher viability performed generally better in fermentation, resulting in faster sugar consumption, faster ethanol production and stability. Handling yeast and serial repitching based on Live/Dead viability measurements, could be the key way to ensure reliable manufacture of high quality beer and to improve process standardization particularly for microbreweries, where variability of production can be a challenging point

LIVE/DEAD YEAST VIABILITY STAINING AS A TOOL FOR IMPROVING ARTISANAL PILSNER BEER PRODUCTION

The production of an artisanal beer, made by brewers using traditional practices on a small scale, is founded on the empirical adjustment of parameters, including yeasts handling and serial repitching. The aim of this study was to monitor yeast viability during different stages of artisanal beer productions through the Live/Dead Yeast viability staining and to correlate it with fermentation dynamics in order to increase process standardization and to maintain the quality of final products. Yeast viability and fermentation activities were evaluated during seven fermentation cycles of an artisanal pilsner beer. Yeast inoculated with higher viability performed generally better in fermentation, resulting in faster sugar consumption, faster ethanol production and stability. Handling yeast and serial repitching based on Live/Dead viability measurements, could be the key way to ensure reliable manufacture of high quality beer and to improve process standardization particularly for microbreweries, where variability of production can be a challenging point

Effectiveness of a management program for outpatient clinic or remote titration of beta-blockers in CRT patients: The RESTORE study

Background Many patients fail to receive β-blockers before cardiac resynchronization therapy defibrillator (CRT-D) implantation, or receive them at a suboptimal dose, and require optimization after implantation. We assessed the effectiveness of a structured program for β-blocker titration in CRT-D patients followed up by means of conventional in-clinic visits or remote monitoring. Methods and results 130 patients undergoing CRT implantation and treated according to the standard practice of the centers were included as a control group. A second group of 124 CRT-D candidates (Study Group) underwent up-titration visits every 2 weeks after implantation (target dose: 10 mg/day of bisoprolol or 50 mg/day of carvedilol). In the Study Group, remote monitoring was undertaken in 66 patients, who received additional equipment for daily transmission of weight and blood pressure data, and scheduled titration telephone calls. In the Control Group, the maximal dose of β-blockers was being administered to 12 (9%) patients on implantation and 21 (16%) on 6-month follow-up examination (p > 0.05). In the Study Group, 25 (20%) patients were receiving the maximal dose of β-blockers on implantation and 72 (58%) on follow-up examination (p < 0.001). The 66 Study Group patients on remote monitoring underwent fewer in-clinic visits (p = 0.034). Of these, 50 (76%) were on the maximal dose after remote up-titration (versus 38% of patients followed up conventionally, p < 0.001). The decrease in left ventricular end-systolic volume was larger in the Study Group (p = 0.040). Conclusions The program for β-blocker up-titration increased the number of patients reaching the target dose and improved the response to the therapy. The use of remote monitoring and daily transfer of weight and blood pressure data facilitated β-blocker titration

Stricter criteria for left bundle branch block diagnosis do not improve response to CRT

BACKGROUND: Cardiac resynchronization therapy (CRT) has proved to be effective in patients with heart failure and left bundle branch block (LBBB). Recently, new ECG criteria have been proposed for the diagnosis of LBBB. These criteria are stricter than the current American Heart Association (AHA) criteria. We assessed the rate of echocardiographic response to CRT in patients with traditional LBBB versus patients who met the new criteria (strict LBBB). METHODS: Consecutive patients undergoing CRT were enrolled in the CRT MORE registry. Patients with no-LBBB QRS morphology according to AHA criteria, atrial fibrillation, right bundle branch block and right ventricular pacing were excluded. Strict LBBB was defined as: QRS 65140ms for men and 65130ms for women, QS or rS in V1-V2, mid-QRS notching or slurring in 652 contiguous leads. Patients showing a relative decrease of 6515% in left ventricular end-systolic volume (LVESV) at 12 months were defined as responders. RESULTS: Among 335 patients with LBBB, 131 (39%) had strict LBBB. Patients with and without strict LBBB showed comparable baseline characteristics, except for QRS duration (166\ub120ms vs 152\ub125ms, p<0.001). On 12-month evaluation, 205 patients (61%) were responders; 85/131 (65%) had strict LBBB and 120/204 (59%) had traditional LBBB (p = 0.267). On multivariate analysis, a history of atrial fibrillation, larger LVESV, and the presence of mid-QRS notching in 651 lead (OR 2.099; 95% CI 1.061 to 4.152, p = 0.033) were independently associated with echocardiographic response. CONCLUSIONS: Stricter definition of LBBB did not improve response to CRT in comparison to the current AHA definition

Prospective evaluation of the multisensor HeartLogic algorithm for heart failure monitoring

The HeartLogic algorithm measures data from multiple implantable cardioverter-defibrillator-based sensors and combines them into a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation

Preliminary experience with the multisensor HeartLogic algorithm for heart failure monitoring: a retrospective case series report

Aims In the Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients study, a novel algorithm for heart failure (HF) monitoring was implemented. The HeartLogic (Boston Scientific) index combines data from multiple implantable cardioverter defibrillator (ICD)-based sensors and has proved to be a sensitive and timely predictor of impending HF decompensation. The remote monitoring of HF patients by means of Heartlogic has never been described in clinical practice. We report post-implantation data collected from sensors, the combined index, and their association with clinical events during follow-up in a group of patients who received a HeartLogic-enabled device in clinical practice.Methods and results Patients with ICD and cardiac resynchronization therapy ICD were remotely monitored. In December 2017, the Heartlogic feature was activated on the remote monitoring platform, and multiple ICD-based sensor data collected since device implantation were made available: Heartlogic index, heart rate, heart sounds, thoracic impedance, respiration, and activity. Their association with clinical events was retrospectively analysed. Data from 58 patients were analysed. During a mean follow-up of 5 +/- 3 months, the HeartLogic index crossed the threshold value (set by default to 16) 24 times (over 24 person-years, 0.99 alerts/patient-year) in 16 patients. HeartLogic alerts preceded five HF hospitalizations and five unplanned in-office visits for HF. Symptoms or signs of HF were also reported at the time of five scheduled visits. The median early warning time and the time spent in alert were longer in the case of hospitalizations than in the case of minor events of clinical deterioration of HF. Heartlogic contributing sensors detected changes in heart sound amplitude (increased third sound and decreased first sound) in all cases of alerts. Patients with Heartlogic alerts during the observation period had higher New York Heart Association class (P = 0.025) and lower ejection fraction (P = 0.016) at the time of activation.Conclusions Our retrospective analysis indicates that the HeartLogic algorithm might be useful to detect gradual worsening of HF and to stratify risk of HF decompensation

Implantable defibrillator-detected heart failure status predicts atrial fibrillation occurrence

BACKGROUND In heart failure (HF) patients, atrial fibrillation (AF) is associated with a worse prognosis. Implantable cardioverter-defibrillator (ICD) diagnostics allow continuous monitoring of AF and are equipped with algorithms for HF moni-toring. OBJECTIVE We evaluated the association between the values of the multisensor HF HeartLogic index and the incidence of AF, and as-sessed the performance of the index in detecting follow-up periods of significantly increased AF risk. METHODS The HeartLogic feature was activated in 568 ICD pa-tients. Median follow-up was 25 months [25th-75th percentile (15-35)]. The HeartLogic algorithm calculates a daily HF index and identifies periods of IN-alert state on the basis of a configurable threshold. The endpoints were daily AF burden &gt;= 5 minutes, &gt;= 6 hours, and &gt;= 23 hours. RESULTS The HeartLogic index crossed the threshold value 1200 times. AF burden &gt;= 5 minutes/day was documented in 183 patients (32%), &gt;= 6 hours/day in 118 patients (21%), and &gt;= 23 hours/day in 89 patients (16%). The weekly time of IN-alert state was independently associated with AF burden &gt;= 5 minutes/day (hazard ratio [HR] 1.95; 95% confidence interval [CI] 1.22- 3.13; P 5 .005), &gt;= 6 hours/day (HR 2.66; 95% CI 1.60-4.44; P &lt;.001), and &gt;= 23 hours/day (HR 3.32; 95% CI 1.83-6.02; P &lt;.001), after correction for baseline confounders. Comparison of the episode rates in the IN-alert state with those in the OUT -of-alert state yielded HR ranging from 1.57 to 3.11 for AF burden from &gt;= 5 minutes to &gt;= 23 hours. CONCLUSIONS The HeartLogic alert state was independently asso-ciated with AF occurrence. The intervals of time defined by the algo-rithm as periods of increased risk of HF allow risk stratification of AF according to various thresholds of daily burden

Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study

Objective. The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing. Background. Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many implanting centers. Methods. The Right Pace study was a multicenter, prospective, single-blind, nonrandomized trial involving 437 patients indicated for dual-chamber pacemaker implantation with a high percentage of RV pacing. Results. RV lead-tip target location was the apex or the interventricular septum. RVA (274) and non-RVA patients (163) did not differ in baseline characteristics. During a median follow-up of 19 months (25th–75th percentiles, 13–25), 17 patients died. The rates of the primary outcome of death due to any cause or hospitalization for heart failure were comparable between the groups (log-rank test, p=0.609), as were the rates of the composite of death due to any cause, hospitalization for heart failure, or an increase in left ventricular end-systolic volume ≥ 15% as compared with the baseline evaluation (secondary outcome, p=0.703). After central adjudication of X-rays, comparison between adjudicated RVA (239 patients) and non-RVA (170 patients) confirmed the absence of difference in the rates of primary (p=0.402) and secondary (p=0.941) outcome. Conclusions. In patients with indications for dual-chamber pacemaker who require a high percentage of ventricular stimulation, RVA or non-RVA pacing resulted in comparable outcomes. This study is registered with ClinicalTrials.gov (identifier: NCT01647490)

Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic

Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity. Methods: The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1&ndash;11), lockdown (weeks 12&ndash;20), post-lockdown (weeks 21&ndash;29). Results: Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15&ndash;2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99&ndash;1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64&ndash;1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely. Conclusions: During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status

Association between amount of biventricular pacing and heart failure status measured by a multisensor implantable defibrillator algorithm

BACKGROUND Achieving a high biventricular pacing percentage (BiV%) is crucial for optimizing outcomes in cardiac resynchroniza tion therapy (CRT). The HeartLogic index, a multiparametric heart failure (HF) risk score, incorporates implantable cardioverter-defi brillator (ICD)-measured variables and has demonstrated its predic tive ability for impending HF decompensation. OBJECTIVE This study aimed to investigate the relationship be tween daily BiV% in CRT ICD patients and their HF status, assessed using the HeartLogic algorithm. METHODS The HeartLogic algorithm was activated in 306 patients across 26 centers, with a median follow-up of 26 months (25th 75th percentile: 15–37). RESULTS During the follow-up period, 619 HeartLogic alerts were recorded in 186 patients. Overall, daily values associated with the best clinical status (highest first heart sound, intrathoracic imped ance, patient activity; lowest combined index, third heart sound, respiration rate, night heart rate) were associated with a BiV% exceeding 99%. We identified 455 instances of BiV% dropping below 98% after consistent pacing periods. Longer episodes of reduced BiV% (hazard ratio: 2.68; 95% CI: 1.02–9.72; P 5 .045) and lower BiV% (hazard ratio: 3.97; 95% CI: 1.74–9.06; P5.001) were linked to a higher risk of HeartLogic alerts. BiV% drops exceeding 7 days predicted alerts with 90% sensitivity (95% CI [74%–98%]) and 55% specificity (95% CI [51%–60%]), while BiV % 96% predicted alerts with 74% sensitivity (95% CI [55% 88%]) and 81% specificity (95% CI [77%–85%]). CONCLUSION A clear correlation was observed between reduced daily BiV% and worsening clinical conditions, as indicated by the HeartLogic index. Importantly, even minor reductions in pacing percentage and duration were associated with an increased risk of HF alerts