INTRODUCTIONPatients receiving maintenance haemodialysis are at risk of catheter-related infections. Up to now, there has been no standardized surveillance tool in Germany to evaluate infection ...events in haemodialysis outpatients. As such, this study aimed to implement an online-based surveillance tool in outpatient dialysis facilities, and to report the first national surveillance data for haemodialysis patients in Germany from October 2019 until September 2021.METHODSOutpatient dialysis facilities reported three types of dialysis-associated infection event (DAIE): bloodstream infections, intravenous antimicrobial starts, and local access site infections. Denominator data were provided by the number of haemodialysis treatments at each facility per month. DAIE rates stratified by vascular access type were calculated.RESULTSIn total, 43 outpatient dialysis facilities reported 723 DAIEs, including 63 bloodstream infections, 439 intravenous antimicrobial starts, and 221 local access site infections. The overall incidence of DAIEs was 0.51 per 1000 dialysis treatments (723/1,413,457) during the surveillance period. The overall incidence of DAIEs was 0.13 per 1000 dialysis treatments among patients with arteriovenous fistulas (AVFs; 126/990,392), 0.41 per 1000 dialysis treatments among patients with arteriovenous grafts (41/99,499), and 1.68 per 1000 dialysis treatments among patients with central venous catheters (CVCs; 535/318,757). The rate ratio of DAIEs between CVC and AVF rates was 13.2 (95% confidence interval 10.9-16.0; P<0.001).DISCUSSIONThese 2-year infection data represent the first standardized data of outpatient dialysis facilities in Germany. Rates of infection were highest among patients with CVCs compared with other vascular access types. This online-based surveillance tool may be helpful to identify effective targets for infection prevention measures in haemodialysis patients.
Background
Whereas propionic acidemia (PA) is a target disease of newborn screening (NBS) in many countries, it is not in others. Data on the benefit of NBS for PA are sparse.
Study design
Twenty PA ...patients diagnosed through NBS were compared to 35 patients diagnosed by selective metabolic screening (SMS) prompted by clinical findings, family history, or routine laboratory test results. Clinical and biochemical data of patients from 16 metabolic centers in Germany, Austria, and Switzerland were evaluated retrospectively. Additionally, assessment of the intelligent quotient (IQ) was performed. In a second step, the number of PA patients who have died within the past 20 years was estimated based on information provided by the participating metabolic centers.
Results
Patients diagnosed through NBS had neither a milder clinical course regarding the number of metabolic crises nor a better neurological outcome. Among NBS patients, 63% were already symptomatic at the time of diagnosis, and <10% of all patients remained asymptomatic. Among all PA patients, 76% were found to be at least mildly mentally retarded, with an IQ <69. IQ was negatively correlated with the number of metabolic decompensations, but not simply with the patients’ age. Physical development was also impaired in the majority of patients. Mortality rates tended to be lower in NBS patients compared with patients diagnosed by SMS.
Conclusion
Early diagnosis of PA through NBS seems to be associated with a lower mortality rate. However, no significant benefit could be shown for surviving patients with regard to their clinical course, including the number of metabolic crises, physical and neurocognitive development, and long-term complications.
Aims
Left atrial catheter ablation of the pulmonary veins (PV) has evolved as an important therapeutic option for the treatment of atrial fibrillation (AF). We aimed to investigate the incidence and ...predictors of silent cerebral embolism associated with PV catheter ablation, detected by diffusion-weighted magnetic resonance imaging (DW-MRI).
Methods and results
We performed a prospective analysis of 53 consecutive patients with persistent or paroxysmal AF that underwent PV ablation and post-procedural cerebral MRI 1 day after lasso catheter-guided ostial PV ablation. Patients were analysed for possible demographical, medical, echocardiographical, and procedural predictors of embolic events. A mean of 3.5 ± 0.5 PVs were ablated per patient. In six patients, DW-MRI depicted new clinically silent microembolism after PV ablation (11%). The number of ineffective medical antiarrhythmic agents prior to ablation procedure was significantly higher in the embolism group (3.3 ± 0.5 vs. 2.2 ± 1.4, P = 0.014). Coronary heart disease (CAD) was more frequent in patients with cerebral embolisms (33 vs. 2%, P = 0.031); left ventricular volume (130 ± 12 vs. 103 ± 26 mL, P = 0.002), and septal wall thickness (13.0 ± 1.4 vs. 7.9 ± 4.8 mm, P = 0.025) were significantly increased.
Conclusion
This study shows a high incidence of silent micro-embolic events after PV ablation. CAD, left ventricular dilatation, and hypertrophy were potential predictors of this complication.
Deficiency of propionyl CoA carboxylase (PCC), a dodecamer of alpha and beta subunits, causes inherited propionic acidemia. We have studied, at the molecular level, PCC in 54 patients from 48 ...families comprised of 96 independent alleles. These patients of various ethnic backgrounds came from research centers and hospitals in Germany, Austria and Switzerland. The thorough clinical characterization of these patients was described in the accompanying paper (Grünert et al.
2012
). In all 54 patients, many of whom originated from consanguineous families, the entire
PCCB
gene was examined by genomic DNA sequencing and in 39 individuals the
PCCA
gene was also studied. In three patients we found mutations in both PCC genes. In addition, in many patients RT-PCR analysis of lymphoblast RNA, lymphoblast enzyme assays, and expression of new mutations in E.coli were carried out. Eight new and eight previously detected mutations were identified in the
PCCA
gene while 15 new and 13 previously detected mutations were found in the
PCCB
gene. One missense mutation, p.V288I in the
PCCB
gene, when expressed in E.coli, yielded 134% of control activity and was consequently classified as a polymorphism in the coding region. Numerous new intronic polymorphisms in both PCC genes were identified. This study adds a considerable amount of new molecular data to the studies of this disease.
To assess the diagnostic value of contrast-enhanced multi-detector computed tomography (MD-CT) for identifying patients with left atrial appendage (LAA) thrombus or circulatory stasis.
124 patients ...with a history of atrial fibrillation and/or cerebral ischemia (83 men, mean age 58.6 ± 12.4 years) and with a clinical indication for MD-CT of the heart and for transesophageal echocardiography (TEE) were included in the study. LAA thrombus or thrombogenic milieu was visually identified in TEE and MD-CT. In addition, MD-CT was analyzed quantitatively measuring the Hounsfield units (HU) of the left atrium (LA), the LAA and the ascending aorta (AA), and calculating the HU ratios LAA/AA (HU LAA/AA) und LAA/LA (HU LAA/LA). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated.
The prevalence of a thrombus or thrombogenic milieu as assessed by TEE was 21.8 %. The HU ratio was lower in patients with thrombus or thrombogenic milieu (HU LAA/AA: 0.590 ± 0.248 vs. 0.909 ± 0.141; p < 0.001 und HU LAA/LA 0.689 ± 0.366 vs. 1.082 ± 0.228; p < 0.001). For the diagnosis of thrombus or a thrombogenic milieu, visual analysis yielded a sensitivity of 81.5 %, a specificity of 96.9 %, a PPV of 87.5 % and a NPV of 95.2 %. By combining visual and quantitative analysis with one criterion being positive, the specificity decreased to 91.8 %, the sensitivity to 77.8 %, the PPV to 72.4 %, and the NPV to 94.9 %.
Visual analysis of the LAA in the evaluation of thrombus or thrombogenic milieu yields a high NPV of 95.1 % and may especially be useful to rule out LAA thrombi in patients with contraindications for TEE. Additional calculation of HU ratios did not improve the diagnostic performance of MD-CT.
• MD-CT can reliably exclude atrial appendage thrombi/thrombogenic milieu. • MD-CT is an alternative method in patients with contraindications to TEE. • Calculation of relative HU ratios does not improve the diagnostic value of MD-CT.
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): BIOTRONIC
Background
During the beginning of the first pandemic wave beginning in spring 2020 a lot ...of elective EP procedures were set on hold. After a few months, the hospitals were allowed to proceed with their planned operations. The current investigation analyzed the changes in the number of cardiac pacemakers (PM) implantations in whole Germany.
Methods
We performed a data retrieval of the number of monthly first-time pacemaker implantations, i.e. single-, dual-chamber, or CRT-P, for the 2019 pre- and 2020 pandemic from the "Institut für das Entgeltsystem im Krankenhaus" (InEK) using OPS codes. This database provides data of all in-hospital procedures in Germany.
Results
The course of the implantation rates (January to September) is highlighted in the two figures, where figure 1 demonstrates the single- and dual-chamber PM, and figure 2 the CRT-P implantations in 2019 (blue line) compared to 2020 (red line). It can be clearly seen, that for the single- and dual-chamber PM, a gap occurs between March and Mai in 2020. On the contrary, for the sicker patients, who are in the need for CRT-P, the lines do no cross, significantly. Moreover, the number of CRT-P first-time implantations increased during May to September 2020.
Discussion
The present study highlights the course of first-time pacemaker implantations throughout the beginning of the COVID-19 pandemic in whole Germany. In contrast to single- and dual-chamber PM implantation rates, the number of CRT-P implantations remained stable during the first three months of the pandemic and then exceeded the rates from 2019. The progressive nature of heart failure resulting in the need for CRT may be one reason for not postponing the first-time implantation in the months March to May 2020.
Abstract
Introduction:
Craniofacial measurements have been shown to be important predictors of obstructive sleep apnea (OSA). Evidence indicates that these measures may inform OSA severity. Studies ...also suggest that genetic factors influence both the risk for OSA and craniofacial morphology. It is possible that underlying genetic architecture modifies the relationship between craniofacial morphology and OSA severity. We hypothesized that the proportion of genetic heterogeneity that is attributable to different ancestries would influence this relationship.
Methods:
Craniofacial photographic measurements, in-lab sleep studies, and genome-wide genotyping data were collected from 454 admixed individuals that were ascertained via the population-based Sao Paulo Epidemiological Sleep Study (EPISONO) cohort. Ancestry proportions were calculated based on four major populations from the 1,000 Genomes Project. We then determined the correlation structure across these ancestry proportions, 40 craniofacial measurements, gender, age, body mass index (BMI), and neck circumference (NC). Additionally, we conducted unsupervised clustering on these data to determine if these traits could identify clinically-meaningful OSA subgroups.
Results:
Genetic ancestry proportions were significantly correlated and predicted several craniofacial measurements, adjusted for age, gender, BMI and NC. Cluster analysis identified two main subgroups, distinguished by gender, NC, overall craniofacial dimensions, and proportions of genetic ancestry. Individuals in Cluster 1 (N=211) had increased apnea-hypopnea indices (AHI, β=7.6;95%CI=4.4–10.7), oxygen desaturation indices (β=7.4;95%CI=4.3–10.4) and more severe OSA, defined by AHI≥30 (OR=2.8;95%CI=1.7–4.9) compared to Cluster 2 (N=243). Increased lower anterior face volume and nose width, as well as decreased African and American ancestry proportions, were strong independent predictors of being assigned to the more severe OSA cluster.
Conclusion:
Using craniofacial photographic measurements, genetic ancestry and anthropometric characteristics, we identified clinically-meaningful OSA subgroups. We expect that measurements of lower anterior face volume and nose width may be useful to inform severity of OSA, in lieu of polysomnography. Furthermore, population genetic structure potentially modifies the relationship of craniofacial morphology with OSA severity. We are currently analyzing genomic data to determine if specific variants are associated with the more severe OSA cluster.
Support (If Any):
AFIP, CNPq and FAPESP (#2014/1259-2).
Background
Remote patient monitoring is a safe and effective alternative for the in-clinic follow-up of patients with cardiovascular implantable electronic devices (CIEDs). However, evidence on the ...patient perspective on remote monitoring is scarce and inconsistent.
Objectives
The primary objective of the REMOTE-CIED study is to evaluate the influence of remote patient monitoring versus in-clinic follow-up on patient-reported outcomes. Secondary objectives are to: 1) identify subgroups of patients who may not be satisfied with remote monitoring; and 2) investigate the cost-effectiveness of remote monitoring.
Methods
The REMOTE-CIED study is an international randomised controlled study that will include 900 consecutive heart failure patients implanted with an implantable cardioverter defibrillator (ICD) compatible with the Boston Scientific LATITUDE® Remote Patient Management system at participating centres in five European countries. Patients will be randomised to remote monitoring or in-clinic follow-up. The In-Clinic group will visit the outpatient clinic every 3–6 months, according to standard practice. The Remote Monitoring group only visits the outpatient clinic at 12 and 24 months post-implantation, other check-ups are performed remotely. Patients are asked to complete questionnaires at five time points during the 2-year follow-up.
Conclusion
The REMOTE-CIED study will provide insight into the patient perspective on remote monitoring in ICD patients, which could help to support patient-centred care in the future.
Intracardiac electrograms (IEGMs) recorded by implantable cardioverter-defibrillators (ICDs) are essential for arrhythmia diagnosis and ICD therapy assessment. Short IEGM snapshots showing 3-10 s ...before arrhythmia detection were added to the Biotronik Home Monitoring system in 2005 as the first-generation IEGM Online. The RIONI study tested the primary hypothesis that experts' ratings regarding the appropriateness of ICD therapy based on IEGM Online and on standard 30 s IEGM differ in <10% of arrhythmia events.
A total of 619 ICD patients were enrolled and followed for 1 year. According to a predefined procedure, 210 events recorded by the ICDs were selected for evaluation. Three expert board members rated the appropriateness of ICD therapy and classified the underlying arrhythmia using coded IEGM Online and standard IEGM to avoid bias. The average duration of IEGM Online was 4.4±1.5 s. According to standard IEGM, the underlying arrhythmia was ventricular in 135 episodes (64.3%), supraventricular in 53 episodes (25.2%), oversensing in 17 episodes (8.1%), and uncertain in 5 episodes (2.4%). The expert board's rating diverged between determinable IEGM Online tracings and standard IEGM in 4.6% of episodes regarding the appropriateness of ICD therapy (95% CI up to 8.0%) and in 6.6% of episodes regarding arrhythmia classification (95% CI up to 10.5%).
By enabling accurate evaluation of the appropriateness of ICD therapy and the underlying arrhythmia, the first-generation IEGM Online provided a clinically effective basis for timely interventions and for optimized patient management schemes, which was comparable with current IEGM recordings.
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