Fixation of the pacemaker leads during pacemaker implantation leads to an increase of cardiac Troponin T (cTnT) that can be interpreted as a sign of minimal myocardial damage. This trial evaluates ...whether the mechanism type of lead fixation influences the magnitude of cTnT release. Patients having a de-novo cardiac pacemaker implantation or a lead revision were centrally randomized to receive either a ventricular lead with an active (screw) or passive (tine) fixation mechanism. High-sensitive Troponin T (hsTnT) was determined on the day of the procedure beforehand and on the following day. 326 Patients (median age (IQR) 75.0 (69.0-80.0) years, 64% male) from six international centers were randomized to receive ventricular leads with an active (n = 166) or passive (n = 160) fixation mechanism. Median (IQR) hsTnT levels increased by 0.009 (0.004-0.021) ng/ml in the group receiving screw-in ventricular leads and by 0.008 (0.003-0.030) ng/ml in the group receiving tined ventricular leads (n.s.). In conclusion pacemaker implantations are followed by a release of hsTnT. The choice between active or passive fixation ventricular leads does not have a significant influence on the extent of myocardial injury and the magnitude of hsTnT release.
The placement of an implantable cardioverter defibrillator (ICD) has become routine practice to protect high risk patients from sudden cardiac death. However, implantation-related myocardial ...micro-damage and its relation to different implantation strategies are poorly characterized.
A total of 194 ICD recipients (64±12 years, 83% male, 95% primary prevention of sudden cardiac death, 35% cardiac resynchronization therapy) were randomly assigned to one of three implantation strategies: (1) ICD implantation without any defibrillation threshold (DFT) testing, (2) estimation of the DFT without arrhythmia induction (modified "upper limit of vulnerability (ULV) testing") or (3) traditional safety margin testing including ventricular arrhythmia induction. High-sensitive Troponin T (hsTnT) levels were determined prior to the implantation and 6 hours after.
All three groups showed a postoperative increase of hsTnT. The mean delta was 0.031±0.032 ng/ml for patients without DFT testing, 0.080±0.067 ng/ml for the modified ULV-testing and 0.064±0.056 ng/ml for patients with traditional safety margin testing. Delta hsTnT was significantly larger in both of the groups with intraoperative ICD testing compared to the non-testing strategy (p≤0.001 each). There was no statistical difference in delta hsTnT between the two groups with intraoperative ICD testing (p = 0.179).
High-sensitive Troponin T release during ICD implantation is significantly higher in patients with intraoperative ICD testing using shock applications compared to those without testing. Shock applications, with or without arrhythmia induction, did not result in a significantly different delta hsTnT. Hence, the ICD shock itself and not ventricular fibrillation seems to cause myocardial micro-damage.
ClinicalTrials.gov NCT01230086.
Background and Aims
COPD is progressive lung disease with known higher cardiovascular (CV) risk, mainly attributed to smoking of cigarettes as the main etiological factor of disease. The aim of this ...study was to compare CV risk in patients with COPD to control groups of smokers and non‐COPD and to investigate the relation of lung function variables, COPD severity, and smoking with Systemic Coronary Risk Estimation (SCORE) risk calculation, arterial stiffness (AS) values, and biological systemic inflammatory markers.
Methods
A total of 208 subjects were included in this study: 61 subjects diagnosed with COPD, 83 smokers without COPD, and 64 nonsmokers without COPD. Medical history and clinical data were recorded, including assessment of pulmonary function and AS, calculation of ankle‐brachial index, blood analysis, and CV risk assessment by SCORE risk calculation.
Results
Subjects with COPD had significantly higher values of SCORE calculation of risk, central aortic pressure, AS, and markers of systemic inflammation compared to control groups of smokers and nonsmokers without COPD (p < 0.001). Furthermore, statistically significant increase in hs‐CRP concentration was found between the COPD group and the control group of non‐COPD smokers (p < 0.001), and a statistically significantly higher SCORE calculation was found in the COPD group compared to control groups of smokers and nonsmokers without COPD (p < 0.001).
Conclusion
The results of the research support further identification and research of biological markers and simple specific tests such as arteriography that will enable progress in personalized treatment of patients with COPD and better primary and secondary prevention of comorbidities with the aim of improved treatment outcome.
The use of cardiac implantable electronic devices (CIED) has risen steadily, yet the rate of cardiac device infections (CDI) has disproportionately increased. Amongst all cardiac device infections, ...the pocket infection is the most challenging diagnosis. Therefore, we aimed to improve diagnosis of such pocket infection by identifying relevant biomarkers.
We enrolled 25 consecutive patients with invasively and microbiologically confirmed pocket infection. None of the patients had any confounding conditions. Pre-operative levels of 14 biomarkers were compared in infected and control (n = 50) patients. Our selected biomarkers included white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), lipopolysaccharide binding protein, high-sensitivity C-reactive protein (HS-CRP), polymorphonuclear-elastase, presepsin, various interleukins, tumor necrosis factor α (TNF-α), and granulocyte macrophage colony-stimulating factor (GM-CSF).
Of the 25 patients with isolated pocket infection (70±13years, 76% male, 40% ICDs), none presented with leukocytosis. In contrast, they had higher serum levels of HS-CRP (p = 0.019) and PCT (p = 0.010) than control patients. Median PCT-level was 0.06 ng/mL (IQR 0.03-0.07 ng/mL) in the study group versus 0.03 ng/mL (IQR 0.02-0.04 ng/mL) in controls. An optimized PCT cut-off value of 0.05 ng/mL suggests pocket infection with a sensitivity of 60% and specificity of 82%. In addition TNF-α- and GM-CSF-levels were lower in the study group. Other biomarkers did not differ between groups.
Diagnosis of isolated pocket infections requires clinical awareness, physical examination, evaluation of blood cultures and echocardiography assessment. Nevertheless, measurement of PCT- and HS-CRP-levels can aid diagnosis. However, no conclusion can be drawn from normal WBC-values.
clinicaltrials.gov identifier: NCT01619267.
Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with ...implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients.
Most frequently used cardiovascular implantable electronic devices for the treatment of arrhythmias are pacemakers and implantable cardioverter defibrillators (ICDs). It has been shown that the ...function of these cardiac rhythm devices can be impaired by electromagnetic interference from the devices and systems emitting magnetic fields, causing either temporary or permanent system malfunction. Methods Literature review 1-3 and own results 4 from the studies examining the potential electromagnetic interference of hand metal detectors among the patients with implanted cardiovascular implantable electronic devices performed in Deutsches Herzzentrum Munich will be used. Results Sources of electromagnetic interference are frequently encountered in daily life, emanating from cellular phones, anti-theft devices, metal detectors, various remote controls, improperly wired/grounded appliances coming into the contact with the body, MP3 players, induction ovens and many other devices 1-3 Increasing global efforts to intensify security screening measures in the past decade have also brought into focus the use of metal detectors (which create a magnetic field that might interfere with the function of cardiovascular implantable electronic devices); they are nowadays routinely used in many settings to detect ferrous and other dangerous items. Patients with pacemakers and implantable cardioverter defibrillators are often advised to avoid screening with metal detectors because of the risk for electromagnetic interference. Another important group of sources of electromagnetic interference is that which is encountered in workplace and/or industrial environments, such as high voltage power lines, transformers, welders, electric motors, and many others. Last, but not least, are those sources are found in the medical environment: magnetic resonance image scanners, electrosurgery, defibrillation, neurostimulators, TENS devices, radiofrequency catheter ablation, and therapeutic diathermy. Conclusions Altough the majority of data available is based on case reports, there are a few studies examining effects of electromagnetic intereference on cardiovascular implantable electronic devices. Majority of problems that occur are transient in nature, and, more important, easily avoidable. Physicians should be aware of and familiarized with the most common interactions of electromagnetic intereference and cardiovascular implantable electronic devices.
The aim of this observational study was to evaluate the effect of Mediterranean and continental nutrition on cardiovascular risk in patients with acute and chronic coronary heart disease in Croatia.
...The study included 1284 patients who were hospitalized in a 28-month period due to acute or chronic ischaemic heart disease in hospitals across Croatia. An individual questionnaire was prepared which enabled recording of various cardiovascular risk factors.
Patients with chronic coronary artery disease have a better index of healthy diet than patients with acute coronary disease. Women have a better index of diet than men in both Croatian regions. When the prevalence of risk factors (impaired glucose tolerance, diabetes mellitus types I and II, hypercholesterolaemia, hypertriglyceridaemia and hypertension) in patients with Mediterranean and continental nutrition is compared, a trend is seen for patients who have risk factors to consume healthier food.
The Mediterranean diet is associated with reduced risk of developing cardiovascular disease. This effect is more evident in patients with known cardiovascular disease.
This report presents a case of pulmonary air embolism during implantation of a cardiac resynchronisation therapy system. For left ventricular pacing the thinnest available coronary sinus lead was ...used in association with a standard subclavian vein introducer sheath. It is hypothesised that the diff erence of size between the small lead diameter and the subclavian vein introducer sheath may have predisposed to air entry into the venous system.
Summary
BACKGROUND: There are few data on differences in exposure to risk factors for coronary heart disease (CHD) in relation to geographic areas, especially areas with large differences in terms of ...continental and Mediterranean climates. To study these differences in Croatia, we analyzed data from the Treatment and Secondary Prevention of Ischemic Coronary Events in Croatia V (TASPIC-CRO V) study, which recruited Croatian CHD patients in two principal regions (Mediterranean and continental) of the country. METHODS: A total of 31 Croatian research centers participated in the study. We collected information on personal details, demographic characteristics and risk factor exposure from the hospital medical records of 3054 CHD patients. Risk factors included history of cigarette smoking, hypertension, hyperlipidemia (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) and diabetes type 2. RESULTS: Both univariate and multivariate analyses showed that the prevalence of hypertension in examined CHD patients was significantly higher in the continental part of Croatia than in the Mediterranean part (univariate analysis:
P
< 0.001; multivariate analysis:
P
= 0.003). Multivariate analysis revealed a higher prevalence of decreased HDL-cholesterol in continental Croatia (
P
= 0.006) and a higher prevalence of smokers in coastal Mediterranean Croatia (
P
= 0.007). A significant difference in total cholesterol levels was noted between hospitalized CHD patients in two Mediterranean subregions (
P
< 0.001). No significant differences between continental and coastal Mediterranean parts of Croatia were found for other CHD risk factors. CONCLUSIONS: Higher prevalences of both hypertension and decreased HDL-cholesterol were recorded in hospitalized CHD patients in the continental part of Croatia, but in coastal Mediterranean Croatia there was higher prevalence of smokers. Differences in total cholesterol, LDL-cholesterol and triglycerides between hospitalized CHD patients in continental and coastal Mediterranean Croatia did not follow the expected continental–Mediterranean pattern.
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