"Cooperatio - Cardiovascular Science"
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Electrical cardioversion presents one of the treatment options for atrial fibrillation (AF). However, the early recurrence rate is high, reaching ~40% three months after the procedure. Features based on vectorcardiographic signals were explored to find association with early recurrence of AF. Eighty-four patients with non-paroxysmal AF referred to electrical cardioversion were prospectively studied; early AF recurrence was present in 40 (47.6%). Patients underwent 24-h Holter ECG monitoring three months after the procedure to assess AF recurrence. Pre-procedural 12-lead ECGs (10 s, 1 kHz) were recorded and automatically analyzed. We explored associations of VCG-based features with early AF recurrence. Two features were strongly associated with AF recurrence: (1) a mean VCG (y-axis) signal slope in a window starting 145 ms before QRS center, lasting for 190 ms (AUC 0.778, p < 0.001), and (2) a mean VCG (z-axis) signal slope in a window starting 60 ms after QRS center, lasting for 465 ms (AUC 0.744, p < 0.001). These features showed higher association to the outcome than eighteen baseline clinical features. Our approach revealed features based on a slope of vectorcardiographic signals. This work also suggests that state of ventricles strongly affects the AF recurrence after electrical cardioversion.
- MeSH
- elektrická defibrilace * MeSH
- elektrokardiografie ambulantní MeSH
- fibrilace síní * terapie patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- recidiva * MeSH
- senioři MeSH
- vektorkardiografie * metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
The aim of this study was to review the literature on the posterior gastric artery, estimate its prevalence and summarize its reported origins. The databases Pubmed, Scopus, Web of Science and Google Scholar were searched to find all studies describing the prevalence and origin of the posterior gastric artery. Pooled prevalences were estimated using a random effects model. Thirty-eight studies with a total of 3366 subjects were included in the analysis. The overall prevalence of the posterior gastric artery was 57.4% (95% CI = 49.1%-65.7%). The prevalence of the posterior gastric artery was significantly higher in surgical studies than in cadaveric and angiographic studies. There were no differences in prevalence between multi-detector computed tomography studies and cadaveric studies, nor were there differences when comparing geographical location or study size. Origin data were extracted from 34 studies, with a total of 1533 cases. The posterior gastric artery arose as a single vessel from the splenic artery in 1160 cases (pooled prevalence 86.5% [95% CI = 78.5%-94.7%]), from the superior polar splenic artery in 339 cases (pooled prevalence 11.8% [95% CI = 3.7%-19.9%]) and from other origins in 50 cases (pooled prevalence 0.27% [95% CI = 0.00-0.71%]). The posterior gastric artery is present in 57.4% of cases and most commonly arises from the splenic artery. It should be identified before gastric resections as it may be an important source of blood to the gastric stump. Multi-detector computed tomography has sufficient sensitivity to detect it before surgery.
StopBac is an innovative silver-impregnated antimicrobial dressing specifically designed to reduce surgical site infections and enhance healing. The primary objective of this study was to compare infection healing rate at 30 days after surgery between primarily closed surgical wounds covered with StopBac and those covered with Cosmorpor, a standard surgical dressing. Between 1.3.2023 and 30.4.2023, we conducted a prospective screening of all patients undergoing surgical operations within a single surgical department. Patients were randomised into either the Cosmopor group or the StopBac group. Outcome measures were superficial and deep surgical site infections and healed wounds. Data concerning patient and surgical factors were prospectively collected and analysed. The analysis comprised 275 patients, divided into two groups: 140 patients in the StopBac group and 135 in the Cosmopor group. The StopBac dressing was associated with a reduced rate of infection, with an odds ratio of 0.288 (p < 0.001), and an increased likelihood of wound healing at 30 days after surgery. The odds ratio for healing at 30 days was 4.661 (p < 0.001). StopBac was associated with a lower incidence of surgical wound infections and a higher probability of healing at 30 days after surgery, when compared with standard dressing.
AIMS: In patients with recently diagnosed non-ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short-term follow-up. The aim of our study was to assess the long-term clinical course and stability of LVRR in these patients. METHODS AND RESULTS: We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy. All patients underwent endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow-up over 5 years. LVRR was defined as the combined presence of (1) LVEF ≥ 50% or increase in LVEF ≥ 10% points and (2) decrease in LV end-diastolic diameter index (LVEDDi) ≥ 10% or (3) LVEDDi ≤ 33 mm/m2. LVRR was observed in 46% patients at 1 year, in 60% at 2 years and 50% at 5 years. Additionally, 2% of patients underwent heart transplantation and 12% experienced heart failure hospitalization. During 5-year follow-up, 23 (17%) of the study cohort died. In multivariate analysis, independent predictors of mortality were baseline right atrial size (OR 1.097, CI 1.007-1.196), logBNP level (OR 2.02, CI 1.14-3.56), and PR interval (OR 1.02, CI 1.006-1.035) (P < 0.05 for all). The number of macrophages on EMB was associated with overall survival in univariate analysis only. LVRR at 1 year of follow-up was associated with a lower rate of mortality and heart failure hospitalization (P = 0.025). In multivariate analysis, independent predictors of LVRR were left ventricular end-diastolic volume index (OR 0.97, CI 0.946-0.988), LVEF (OR 0.89, CI 0.83-0.96), and diastolic blood pressure (OR 1.04, CI 1.01-1.08) (P < 0.05 for all). CONCLUSIONS: LVRR occurs in over half of patients with recent onset unexplained LV systolic dysfunction during first 2 years of optimally guided heart failure therapy and then remains relatively stable during 5-year follow-up. Normalization of adverse LV remodelling corresponds to a low rate of mortality and heart failure hospitalizations during long-term follow-up.
