Left Ventricular Diastolic Dysfunction Screening by a Smartphone-Case Based on Single Lead ECG.

Aims To investigate the potential of a signal processed by smartphone-case based on single lead electrocardiogram (ECG) for left ventricular diastolic dysfunction (LVDD) determination as a screening method. Methods and Results We included 446 subjects for sample learning and 259 patients for sample test aged 39 to 74 years for testing with 2D-echocardiography, tissue Doppler imaging and ECG using a smartphone-case based single lead ECG monitor for the assessment of LVDD. Spectral analysis of ECG signals (spECG) has been used in combination with advanced signal processing and artificial intelligence methods. Wavelengths slope, time intervals between waves, amplitudes at different points of the ECG complexes, energy of the ECG signal and asymmetry indices were analyzed. The QTc interval indicated significant diastolic dysfunction with a sensitivity of 78% and a specificity of 65%, a Tpeak parameter >590 ms with 63% and 58%, a T value off >695 ms with 63% and 74%, and QRSfi > 674 ms with 74% and 57%, respectively. A combination of the threshold values from all 4 parameters increased sensitivity to 86% and specificity to 70%, respectively (OR 11.7 [2.7-50.9], P < .001). Algorithm approbation have shown: Sensitivity-95.6%, Specificity-97.7%, Diagnostic accuracy-96.5% and Repeatability-98.8%. Conclusion Our results indicate a great potential of a smartphone-case based on single lead ECG as novel screening tool for LVDD if spECG is used in combination with advanced signal processing and machine learning technologies

ПРОТЕЗИРОВАНИЕ АОРТАЛЬНОГО КЛАПАНА АУТОПЕРИКАРДОМ БЕЗ ИСПОЛЬЗОВАНИЯ ШАБЛОНОВ: НЕПОСРЕДСТВЕННЫЕ И СРЕДНЕОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ

HighlightsWe have described the outcomes of aortic valve replacement using autologous pericardium without special templates. Although S. Ozaki is considered by many to be the founder of neocuspidization technique, the methods for sizing of the neocusps were proposed long before him. The method of the Japanese professor involves using special templates. This article presents a mathematical formula to calculate neocusps` size, which significantly simplifies the procedure, and makes it possible to perform it in centers that do not possess Ozaki templates. Abstract Aim: To describe an original technique of aortic valve replacement using autologous pericardium without templates. The calculation of the neocusps` size is based on the diameter of aortic annulus, which can be estimated both intraoperatively and preoperatively, helps to reduce the duration of surgery, CPB time and myocardial ischemia, and lower the rates of late complications.Methods: The prospective study included 34 patients with aortic valve disease admitted to the Cardiac Surgical Department of the University Clinical Hospital No.1 of the First Moscow State Medical University named after I.M. Sechenov, Ministry of Health of Russia in the period from January 2020 to March 2023. The mean age of the patients was 51±17 years (from 19 to 78 years). Gender distribution in the total group was as follows: male 50% (n = 17), female 50% (n = 17). All patients underwent aortic valve replacement using autologous pericardium without templates (by calculating the neocusps` size). Isolated aortic valve replacement was performed in 17 patients (50%), ascending aorta replacement in 11 patients (32.3%), mitral valve intervention in 5 (14.7%), coronary artery bypass grafting in 3 (8.8%) cases. 11 patients (32.3%) had aortic valve stenosis, 4 patients (11.7%) had insufficiency, and 19 patients (55.8%) had both stenosis and insufficiency. Bicuspid aortic valve was detected in 18 patients (52.9%). All patients were divided into two groups: Komarov (aortic valve replacement only) and Komarov Plus (aortic valve replacement and treatment for concomitant cardiac pathology).Results: There were no cases of conversion to traditional aortic valve replacement using prosthetic valves. There were 2 cases of in-hospital mortality; according to medical records, death in both cases was due to complications provoked by double pneumonia caused by SARS-CoV-2. 1 patient required reoperation 4 months after the intervention due endocarditis caused by Streptococcus viridans. In the midterm follow-up period, hemodynamic parameters such as peak gradient, mean gradient, and peak velocity were 11.96±4.70 mm Hg, 5.88±2.07 mm Hg, 168.19±30.56 mm Hg.Conclusions: The obtained valve prosthesis is anatomically analogous to the native valve and provides reliable peak pressure reduction, no postoperative regurgitation, and increased effective orifice area. The proposed method is safe and can serve as an alternative to the Ozaki procedure, in which the neocusps are outlined using special templates.Основные положения Продемонстрированы результаты протезирования аортального клапана аутоперикардом без использования шаблонов. Родоначальником неокуспидизации принято считать S. Ozaki, однако методы расчета неостворки из перикарда предложены задолго до него. Методика японского профессора заключается в использовании специальных шаблонов. В данной статье представлен математический расчет створки, выполненный хирургами Сеченовского Университета, позволяющий не только существенно упростить процедуру, но и выполнять ее в тех центрах, где шаблонов Ozaki нет. Резюме Цель: Описана оригинальная методика полной реконструкции аортального клапана аутоперикардом. Расчет формы неостворок осуществлен на основании данных о диаметре фиброзного кольца, которые могут быть получены как во время, так и до операции, что позволяет сократить время вмешательства, искусственного кровообращения и ишемии миокарда, а в конечном итоге добиться снижения ишемии головного мозга и снизить вероятность поздних осложнений.Материалы и методы: Проведено проспективное исследование 34 пациентов, оперированных по поводу порока аортального клапана в кардиохирургическом отделении Университетской клинической больницы № 1 ФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава России (Сеченовский Университет) в период с января 2020 г. по март 2023 г. Средний период наблюдения для всей когорты составил 14,1±7,7 мес. Средний возраст больных – 51±17 лет (19–78 лет). Гендерное распределение в общей группе: мужской пол – 50% (n = 17), женский – 50% (n = 17). Всем пациентам выполнено протезирование аортального клапана аутоперикардом без использования шаблонов (расчетным способом). 17 (50%) больным проведена изолированная коррекция порока аортального клапана, 11 (32,3%) – протезирование восходящей аорты, 5 (14,7%) – вмешательство на митральном клапане, в 3 (8,8%) случаях выполнено коронарное шунтирование. Стеноз аортального клапана отмечен у 11 (32,3%) пациентов, недостаточность – у 4 (11,7%), стеноз и недостаточность – у 19 (55,8%). Двустворчатый аортальный клапан выявлен у 18 (52,9%) больных. Все пациенты разделены на две группы: Komarov (изолированная коррекция порока аортального клапана) и Komarov Plus (коррекция порока аортального клапана с сопутствующей кардиальной патологией).Результаты: Не зарегистрировано случаев конверсии в стандартное протезирование аортального клапана. Зафиксировано два случая госпитальной летальности; по данным патологоанатомического заключения, смерть в обоих случаях наступила из-за осложнений, спровоцированных двусторонней полисегментарной пневмонией, вызванной SARS-CoV-2. Одному пациенту через 4 мес. после вмешательства потребовалась повторная операция вследствие развившегося эндокардита, возбудитель Streptococcus viridans. В среднеотдаленном периоде гемодинамические показатели, такие как пиковый градиент, средний градиент и пиковая скорость, составили 11,96±4,70, 5,88±2,07 мм рт. ст. и 168,19±30,56 см/с.Заключение: Конечный вид протеза служит анатомическим аналогом нативного клапана и обеспечивает достоверное снижение пикового давления, отсутствие регургитации на клапане после операции и увеличение площади эффективного отверстия. Данный метод можно рассматривать как безопасную альтернативу процедуре Ozaki, при которой створки выкраивают с помощью специальных шаблонов

The Effects of Intermittent Hypoxic–Hyperoxic Exposures on Lipid Profile and Inflammation in Patients With Metabolic Syndrome

Background: Patients with metabolic syndrome (MS) tend to suffer from comorbidities, and are often simultaneously affected by obesity, dysglycemia, hypertension, and dyslipidemia. This syndrome can be reversed if it is timely diagnosed and treated with a combination of risk factors-reducing lifestyle changes and a tailored pharmacological plan. Interval hypoxic-hyperoxic training (IHHT) has been shown as an effective program in reducing cardiovascular risk factors in patients with MS even in the absence of exercise. However, the influence of IHHT on the lipid profile and inflammation in this clinical population remains relatively unknown.Methods: A prospective, single-center, randomized controlled trial was conducted on 65 (33 men) patients with MS aged 29–74 years, who were randomly allocated to the IHHT or control (sham) experimental groups. The IHHT group completed a 3-week, 5 days/week intermittent exposure to hypoxia and hyperoxia. The control (sham) group followed the same protocol but was breathing room air instead. The primary endpoints were the lipid profile (concentrations of total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides [TG]) and the inflammatory factors such as high-sensitivity C-reactive protein (hs-CRP), galectin-3, heat shock proteins (Hsp70). The secondary endpoints were alanine aminotransferase (ALT), aspartate aminotransferase (AST), N-terminal pro-hormone of brain natriuretic peptide level (NTproBNP), transforming growth factor beta-1 (TGF-beta1), heart-type fatty acid-binding protein (H-FABP), and nitric oxide synthase 2 (NOS2).Results: There were no differences between the two groups but the different baseline values have affected these results. The IHHT group demonstrated pre-post decrease in total cholesterol (p = 0.001), LDL (p = 0.001), and TG levels (p = 0.001). We have also found a decrease in the CRP-hs (p = 0.015) and Hsp70 (p = 0.006) in IHHT-group after intervention, and a significant decrease in pre-post (delta) differences of NTproBNP (p &amp;lt; 0.0001) in the IHHT group compared to the control group. In addition, the patients of the IHHT group showed a statistically significant decrease in pre-post differences of ALT and AST levels in comparison with the control group (p = 0.001). No significant IHHT complications or serious adverse events were observed.Conclusions: The IHHT appears to improve lipid profile and anti-inflammatory status. It is a safe, well-tolerated procedure, and could be recommended as an auxiliary treatment in patients suffering from MS, however, the experiment results were limited by the baseline group differences.Clinical Trial Registration:ClinicalTrials.gov, identifier [NCT04791397]. Evaluation of the effect of IHHT on vascular stiffness and elasticity of the liver tissue in patients with MS.</jats:p