Clinical and electrocardiographic covariates of deceleration capacity in patients with ST-segment elevation myocardial infarction

Background: Deceleration capacity (DC) is a novel electrocardiography (ECG) parameter characterizing the overall capacity of slowing down the heart rate. The aim of this study was to evaluate clinical and ECG covariates of DC in patients with the first episode of ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty. Methods: Deceleration capacity, heart rate variability (HRV) and heart rate turbulence (HRT) were assessed from 24-hour ECG Holter recordings in 70 patients (66 male, mean age 57 years) with STEMI. Deceleration capacity was evaluated as continuous or dichotomized (£ 4.5 vs. > 4.5 ms) variable. Results: The median value of DC was 5.12 ms. Thirty patients (43%) had abnormal DC (£ 4.5 ms). The abnormal DC was more common in female, older and hypertensive patients. Although DC was not associated with either STEMI localization or left ventricular ejection fraction, it was significantly correlated with mean heart rate, standard HRV indices and HRT slope. Multivariate logistic regression showed that hypertension (OR = 3.23, 95% CI = 1.1-9.9, p = 0.039) and mean heart rate > 70 beats/minute (OR = 6.05, 95% CI = 2.0-18.4, p = 0.001) were independently associated with abnormal DC. Conclusions: Deceleration capacity in patients with the first STEMI treated with primary angioplasty is influenced by age, gender, hypertension and heart rate, but not the location of myocardial infarction or left ventricular ejection fraction. Correlation between DC and HRV indices suggests that DC is related to autonomic modulation of heart rate

Kardiowersja elektryczna migotania przedsionków - 40 lat od wprowadzenia metody do praktyki klinicznej

Migotanie przedsionków jest najczęściej występującą arytmią w praktyce klinicznej. Mimo 4 dekad od wprowadzenia kardiowersji elektrycznej do praktyki klinicznej metoda ta pozostaje najbardziej skutecznym sposobem przywrócenia rytmu zatokowego. Niniejsze opracowanie przedstawia aktualne poglądy dotyczące zastosowania i przeprowadzenia kardiowersji elektrycznej, właściwego przygotowania chorego do zabiegu oraz potencjalnych zagrożeń związanych z wykonywaniem tej procedury medycznej. Omówiono również możliwości nowych defibrylatorów wyposażonych w funkcję aplikacji prądu o morfologii dwufazowej. (Folia Cardiologica Excerpta 2006; 1: 473-478

Three-dimensional myocardial strain estimation from volumetric ultrasound: experimental validation in an animal model

Although real-time three-dimensional echocardiography has the potential to allow for more accurate assessment of global and regional ventricular dynamics compared to the more traditional two-dimensional ultrasound examinations, it still requires rigorous testing and validation against other accepted techniques should it breakthrough as a standard examination in routine clinical practice. Very few studies have looked at a validation of regional functional indices in an in-vivo context. The aim of the present study therefore was to validate a previously proposed 3D strain estimation-method based on elastic registration of subsequent volumes on a segmental level in an animal model. Volumetric images were acquired with a GE Vivid7 ultrasound system in five open-chest sheep instrumented with ultrasonic microcrystals. Radial (epsilon(RR)), longitudinal (epsilon(LL)) and circumferential strain (epsilon(CC)) were estimated during four stages: at rest, during esmolol and dobutamine infusion, and during acute ischemia. Moderate correlations for epsilon(LL) (r=0.63; p<0.01) and epsilon(CC) (r=0.60; p=0.01) were obtained, whereas no significant radial correlation was found. These findings are comparable to the performance of the current state-of-the-art commercial 3D speckle tracking methods

Elastic image registration versus speckle tracking for 2-D myocardial motion estimation: a direct comparison in vivo

Despite the availability of multiple solutions for assessing myocardial strain by ultrasound, little is currently known about the relative performance of the different methods. In this study, we sought to contrast two strain estimation techniques directly (speckle tracking and elastic registration) in an in vivo setting by comparing both to a gold standard reference measurement. In five open-chest sheep instrumented with ultrasonic microcrystals, 2-D images were acquired with a GE Vivid7 ultrasound system. Radial (epsilon(RR)) , longitudinal (epsilon(LL)) , and circumferential strain (epsilon(CC)) were estimated during four inotropic stages: at rest, during esmolol and dobutamine infusion, and during acute ischemia. The correlation of the end-systolic strain values of a well-validated speckle tracking approach and an elastic registration method against sonomicrometry were comparable for epsilon(LL) (r = 0.70 versus r = 0.61, respectively; p = 0.32) and epsilon(CC) (r = 0.73 versus r = 0.80 respectively; p = 0.31). However, the elastic registration method performed considerably better for epsilon(RR) (r = 0.64 versus r = 0.85 respectively; p = 0.09). Moreover, the bias and limits of agreement with respect to the reference strain estimates were statistically significantly smaller in this direction (p < 0.001). This could be related to regularization which is imposed during the motion estimation process as opposed to an a posteriori regularization step in the speckle tracking method. Whether one method outperforms the other in detecting dysfunctional regions remains the topic of future research

Non-conducted supraventricular beats or retrograde atrial activation? One ECG strip, two interpretations

W artykule przedstawiono opis przypadku młodej pacjentki z wywiadem napadowych częstoskurczów nadkomorowych poddanej inwazyjnemu badaniu elektrofizjologicznemu i jednoczasowo ablacji drogi wolnej węzła przedsionkowo-komorowego. W 24-godzinnym monitorowaniu elektrokardiograficznym metodą Holtera, wykonanym dobę po zabiegu, okresowo obserwowano zapis, który, zdaniem autorów, można równoprawnie interpretować na dwa sposoby — jako przedwczesne pobudzenia przedsionkowe zablokowane lub wsteczną aktywację przedsionków.This article presents a case of a young female patient with a history of paroxysmal supraventricular tachycardia subjected to electrophysiology study and an atrioventricular node slow pathway ablation. The 24-hour Holter ECG monitoring was performed the day after the procedure. According to the authors ECG recording can be equally interpreted in two ways — as blocked premature atrial beats or retrograde atrial activation

A pseudodysfunction of dual chamber pacemaker — an unusual switch of atrial to ventricular pacing and vice versa observed in Holter monitoring

W przypadku pacjentów z implantowanymi elektronicznymi urządzeniami kardiologicznymi (CIED), takimi jak rozrusznik serca lub kardiowerter-defibrylator, ocena badań elektrokardiograficznych może nastręczać trudności. Autorzy przedstawili przypadek 67-letniego mężczyzny ze wszczepionym, z powodu dysfunkcji węzła zatokowego, dwujamowym kardiostymulatorem. W 24-godzinnym EKG metodą Holtera powtarzalnie obserwowano nietypowe zjawisko zmiany stymulacji z przedsionkowej na komorową i odwrotnie. Pacjent był konsultowany w ośrodku elektrokardiologii inwazyjnej z rozpoznaniem zaburzeń pracy stymulatora. Uproszczone badanie elektrofizjologiczne, przeprowadzone przy użyciu oprogramowania kardiostymulatora, doprowadziło do wyjaśnienia obserwowanych zjawisk. Często nietypowe zjawiska obserwowane w EKG imitują dysfunkcję CIED, co może prowadzić do błędnego stwierdzenia awarii wszczepionego układu. Jednak dokładna analiza zapisów, ze szczególnym uwzględnieniem mechanizmów algorytmów urządzeń wszczepialnych, pozwala na postawienie właściwej diagnozy. W prezentowanym przypadku przeprogramowanie urządzenia w prosty i szybki sposób rozwiązało przedstawiony problem kliniczny i doprowadziło do zaniechania dalszych, zbędnych działań diagnostyczno-leczniczych.In patients with cardiac implantable electronic device (CIED), i.e. pacemaker or implantable cardioverter-defibrillator, interpretation of electrocardiographic tracings may be sometimes difficult. We present a 67-year-old male with a dual chamber pacemaker implanted due to the sinus node dysfunction. A 24-hour Holter monitoring revealed an unusual switching from atrial to ventricular pacing and vice versa. The patient was consulted in Invasive Electrocardiology Unit with a diagnosis of pacemaker dysfunction. The simplified electrocardiophysiologic study was performed using pacemaker modalities, which led to understanding the observed phenomena. Often unusual phenomena observed in electrocardiograms imitate dysfunctions of CIED, which may lead to misdiagnosis of a malfunction of the implanted system. However, detailed analysis of the tracings with special attention to mechanisms of device algorithms, led to proper diagnosis. In presented case, a reprogramming of the device appeared to be curative, and further interventions, being pointless, were discarded

Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey.

UNLABELLED: EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1-10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40-45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged. KEY POINTS: • EUSOBI and 30 national breast radiology bodies support screening mammography. • A first priority is double-reading biennial mammography for women aged 50-69 years. • Extension to 73-75 and from 40-45 to 49 years is also encouraged. • Digital mammography (not film-screen or computer radiography) should be used. • DBT is set to become "routine mammography" in the screening setting in the next future

Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe

In 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016-2018. Most E30 cases affected persons 0-4 years of age (29%) and 25-34 years of age (27%). Sequences were divided into 6 genetic clades (G1-G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >= 2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.Peer reviewe