Energy wavelet signal processed ECG and standard 12 lead ECG: Diagnosis of early diastolic dysfunction.

Background: Left ventricular (LV) diastolic dysfunction (LVDD) is the result of impaired LV relaxation and identifies those at risk of developing heart failure. Echocardiography has been used as the gold standard to identify early LVDD. The signal processed electrocardiogram (hsECG) has demonstrated effectiveness to detect early LVDD.

Supporting Children and Families in Medical Settings: Insights from Child Life Specialists During the COVID-19 Pandemic.

Medical settings can be frightening and stressful places for pediatric patients and their families. During the COVID-19 pandemic fear and anxiety associated with receiving medical care increased as medical facilities dramatically altered the way they functioned in attempts to stop the spread of the virus. Certified Child Life Specialists (CCLSs) are medical professionals who provide psychosocial support for pediatric patients and their families by helping them understand and cope with medical procedures and the medical environment.

Rate pressure product, age predicted maximum heart rate or heart rate reserve. Which one better predicts cardiovascular events following exercise stress echocardiography?

Background: Age-predicted maximum heart rate (APMHR) has been demonstrated to be a poor predictor of future cardiovascular (CV) events and is yet to be validated as a termination point during exercise testing. In contrast, maximum rate pressure product (MRPP) is recognized as a strong predictor of CV outcome with superior CV event prediction over APMHR. Heart rate reserve (HRR) has been shown to be a powerful predictor of CV mortality during exercise testing, however thus far, this is not confirmed for non-fatal CV events.

Safety and Efficacy of Scientist Led Exercise Stress Testing for Arrhythmia Provocation and Chronotropic Competence.

For many years, non physician led exercise stress testing performed for the investigation of coronary artery disease has been endorsed by many cardiovascular (CV) societies and associations around the world. The safety guidelines don't currently include the performing of these tests for arrhythmia provocation or chronotropic assessment. Therefore, the aim of this study was to assess the safety and efficacy of non physician led EST performed for suspected arrhythmias, chronotropic competence, long QT, and accessory pathway conduction (APC) assessment.

Three-dimensional echocardiographic acquisition and validity of left ventricular volumes and ejection fraction.

Transthoracic (TTE) and transesophageal (TEE) three-dimensional echocardiography (3DE) is now used in daily clinical practice. Advancements in technology have improved image acquisition with higher frame rates and increased resolution. Different 3DE acquisition techniques can be used depending upon the structure of interest and if volumetric analysis is required.

Scientist-led Exercise Testing Is Safe With Diagnostic Interpretation Equivalent to a Cardiologist.

Background: The implementation of nonphysician-led exercise stress testing (EST) has increased over the last 30 years, with endorsement by many cardiovascular societies around the world. The comparable safety of nonphysician-led EST to physician-led studies has been demonstrated, with some studies also showing agreement in diagnostic preliminary interpretations.

Objective: The study aim was to firstly confirm the safety of nonphysician-led EST in a large cohort and secondly compare the interobserver agreement and diagnostic accuracy of cardiac scientist and junior medical officer (JMO)-led EST reports to cardiology consultant overreads.

Comparison of heart rate reserve, age predicted maximum heart rate and rate pressure product as predictors of future cardiovascular events following a negative dobutamine stress echocardiogram.

Dobutamine stress echocardiography (DSE) is a commonly used diagnostic stress test for the assessment of various cardiac pathologies on patients unable to perform exercise. Unlike exercise, there is no reliable subjective termination end-point such as fatigue to rely on. Consequently, DSE's are often concluded at a predetermined age predicted maximal heart rate (APMHR) such as 85%.

Comparison of Heart Rate Blood Pressure Product Versus Age-Predicted Maximum Heart Rate as Predictors of Cardiovascular Events During Exercise Stress Echocardiography.

Exercise stress echocardiograms (ESEs) are a functional cardiovascular (CV) test typically used for the investigation of coronary artery disease. ESEs are often terminated at a predetermined age-predicted maximum heart rate (APMHR) to facilitate timely acquisition of ultrasound images at peak exercise. Although an APMHR of 85% is often used, this has not been validated as a suitable termination end point.

Handrail support produces a higher rate pressure product in apparently healthy non-treadmill users during maximal exercise testing.

Objective: Exercise treadmill testing (ETT) is a well-established procedure for the diagnosis, prognosis and functional assessment of patients with suspected cardiovascular disease. The use of handrail support during ETT is often discouraged as this has been demonstrated to overestimate functional capacity. It is unknown if this increase in functional capacity translates to an increase in cardiac workload.

Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise stress test? A single center observational study.

Background: Exercise stress testing (EST) in patients with poor functional capacity measured by time on treadmill is typically deemed inconclusive and usually leads to further downstream testing. The aim of this study was firstly to evaluate the maximum rate pressure product (MRPP) during initial EST to assessthe need for follow-up testing; and secondly to investigate if MRPP is better than age predicted maximum heart rate (APMHR) for diagnostic outcome based on follow up cardiovascular (CV) events in patients with inconclusive EST due to poor functional capacity.

Methods: From a total of 2761 tests performed, 236 tests were considered inconclusive due to poor functional capacity which were available for analysis.

Two Models to Conduct Nonphysician-led Exercise Stress Testing in Low to Intermediate Risk Patients.

Background: Exercise stress testing (EST) is a noninvasive procedure that aids the diagnosis and prognosis of a range of cardiac pathologies. Reduced access is recognized as a limiting factor in enabling early access to treatment or safe and appropriate discharge. Increased accessibility can be achieved by utilizing nonphysician health practitioners to supervise tests.

Association of Exercise Intolerance in Type 2 Diabetes With Skeletal Muscle Blood Flow Reserve.

Objectives: This study sought to investigate the association of exercise intolerance in type 2 diabetes (T2DM) with skeletal muscle capillary blood flow (CBF) reserve.

Background: Exercise intolerance in T2DM strongly predicts adverse prognosis, but associations with muscle blood flow independent of cardiac dysfunction are undefined.

Methods: In 134 T2DM patients without cardiovascular disease, left ventricular function and contrast-enhanced ultrasound of the quadriceps (for CBF; i.

A six-month exercise intervention in subclinical diabetic heart disease: effects on exercise capacity, autonomic and myocardial function.

Objective: Autonomic dysfunction may contribute to the etiology and exercise intolerance of subclinical diabetic heart disease. This study sought the efficacy of exercise training for improvement of peak oxygen uptake (VO₂(peak)) and cardiac autonomic function in type 2 diabetic patients with non-ischemic subclinical left-ventricular (LV) dysfunction.

Materials/methods: Forty-nine type 2 diabetic patients with early diastolic tissue Doppler velocity >1 standard deviation below the age-based mean entered an exercise intervention (n=24) or usual care (n=25) for 6-months (controlled, pre-/post- design).

Biomarker and imaging responses to spironolactone in subclinical diabetic cardiomyopathy.

Background: Subclinical diabetic cardiomyopathy (DCM) is frequent in asymptomatic subjects with type 2 diabetes (T2DM). We sought the response of functional and fibrosis markers to therapy in a trial of aldosterone antagonism for treatment of DCM.

Methods: Biochemical, anthropometric, and echocardiographic data were measured in 225 subjects with T2DM.

Association of outcome with left ventricular parameters measured by two-dimensional and three-dimensional echocardiography in patients at high cardiovascular risk.

Background: Left ventricular (LV) ejection fraction (EF) measured by two-dimensional echocardiographic (2DE) imaging is an important correlate of survival. Real-time three-dimensional echocardiographic (3DE) imaging has addressed some of the limitations of 2DE imaging. The aim of this study was to determine whether 3DE imaging is more predictive of outcomes than 2DE imaging.

Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise.

Background: Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE.

Methods: In this randomized, double-blind, placebo-controlled study of 115 patients (54 ± 9 years, 57% men) with an HRE (≥210/105 mm Hg in men; ≥190/105 mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%.

Real-time 3D echocardiographic quantification of left atrial volume: multicenter study for validation with CMR.

Objectives: We studied in a multicenter setting the accuracy and reproducibility of 3-dimensional echocardiography (3DE)-derived measurements of left atrial volume (LAV) using new, dedicated volumetric software, side by side with 2-dimensional echocardiography (2DE), using cardiac magnetic resonance (CMR) imaging as a reference.

Background: Increased LAV is associated with adverse cardiovascular outcomes. Although LAV measurements are routinely performed using 2DE, this methodology is limited because it is view dependent and relies on geometric assumptions regarding left atrial shape.

Body lift perforator flap breast reconstruction: a review of 100 flaps in 25 cases.

Background: Advances in autologous breast reconstruction continue to mount and have been fueled most substantially with refinement of perforator flap techniques.

Methods: For patients with a desire for autogenous breast reconstruction and insufficient abdominal fat for conventional abdominal flaps, secondary options such as gluteal perforator flaps or latissimus flaps are usually considered. Patients who also have insufficient soft tissue in the gluteal donor site and preference to avoid an implant, present a vexing problem.

Association of imaging markers of myocardial fibrosis with metabolic and functional disturbances in early diabetic cardiomyopathy.

Background: Metabolic and vascular disturbances contribute to diabetic cardiomyopathy, but the role of interstitial fibrosis in early disease is unproven. We sought to assess the relationship between imaging markers of diffuse fibrosis and myocardial dysfunction and to link this to possible causes of early diabetic cardiomyopathy.

Methods And Results: Hemodynamic and metabolic data were measured in 67 subjects with type 2 diabetes mellitus (age 60±10 years) with no cardiac symptoms.

Central hemodynamics and cardiovascular risk in nondippers.

Failure of blood pressure (BP) to decline appropriately overnight (nondipping) is associated with increased risk. This may be due to inappropriately raised supine central BP and this study's first aim was to examine this hypothesis. Secondly, aortic stiffness, central hemodynamics, and left ventricular (LV) mass were measured as other possible mechanisms of higher risk.

Augmentation index immediately after maximal exercise in patients with type 2 diabetes mellitus.

Introduction: Patients with type 2 diabetes mellitus (T2DM) have exaggerated brachial and central (ascending aortic) blood pressure (BP) during exercise, which is associated with adverse outcomes. Central systolic loading, represented by the augmentation index (AIx), may contribute to exaggerated exercise central BP. This study sought to compare the central AIx response to peak exercise in T2DM and control patients and to identify mechanisms of altered exercise central AIx.

Association of masked hypertension and left ventricular remodeling with the hypertensive response to exercise.

Background: A hypertensive response to exercise (HRE; defined as normal clinic blood pressure (BP) and exercise systolic BP (SBP) ≥210 mm Hg in men or ≥190 mm Hg in women, or diastolic BP (DBP) ≥105 mm Hg) independently predicts mortality. The mechanisms remain unclear but may be related to masked hypertension. This study aimed to assess the prevalence of masked hypertension and its association with cardiovascular risk factors, including left ventricular (LV) mass, in patients with a HRE.

Treatment of acute otitis media in children under 2 years of age.

Background: Recommendations vary regarding immediate antimicrobial treatment versus watchful waiting for children younger than 2 years of age with acute otitis media.

Methods: We randomly assigned 291 children 6 to 23 months of age, with acute otitis media diagnosed with the use of stringent criteria, to receive amoxicillin-clavulanate or placebo for 10 days. We measured symptomatic response and rates of clinical failure.

Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in type 2 diabetes.

Objectives: The purpose of this study was to investigate the independent association between global cardiac autonomic neuropathy (CAN) and left ventricular (LV) dysfunction in addition to regional associations of LV dysinnervation and function, in patients with type 2 diabetes mellitus (T2DM).

Background: CAN represents a potential mechanism in the etiology of nonischemic diabetic cardiomyopathy.

Methods: Clinical measures of CAN based on total spectral power of heart rate variability and cardiac reflex testing and echocardiographic assessment of LV function were performed in 118 patients with type 2 diabetes mellitus.