Microbial response to Nature-Based Solutions in urban soils: A comprehensive analysis using Biolog® EcoPlates™

The study presents a comprehensive examination of changes in soil microbial functional diversity (hereafter called microbial activity) following the implementation of Nature-Based Solutions (NBS) in urban areas. Utilizing the Biolog® EcoPlates™ technique, the study explored variations in microbial diversity in urban soil under NBSs implementation across timespan of two years. Significant differences in microbial activity were observed between control location and those with NBS implementations, with seasonal variations playing a crucial role. NBS positively impacted soil microbial activity especially at two locations: infiltration basin and wild flower meadow showing the most substantial increase after NBS implementation. The study links rainfall levels to microbial functional diversity, highlighting the influence of climatic conditions on soil microbiome. The research investigates also the utilization of different carbon sources by soil microorganisms, shedding light on the specificity of substrate utilization across seasons and locations. The results demonstrate that NBSs implementations lead to changes in substrate utilization patterns, emphasizing the positive influence of NBS on soil microbial communities. Likewise, biodiversity indices, such as Shannon-Weaver diversity (H'), Shannon Evenness Index (E), and substrate richness index (S), exhibit significant variations in response to NBS. Notably, NBS implementation positively impacted H' and E indexes, especially in infiltration basin and wild flower meadow, underlining the benefits of NBS for enhancing microbial diversity. The obtained results demonstrated valuable insight into the dynamic interactions between NBS implementation and soil microbial activity. The findings underscore the potential of NBS to positively influence soil microbial diversity in urban environments, contributing to urban sustainability and soil health. The study emphasizes the importance of monitoring soil microbial activity to assess the effectiveness of NBS interventions and guides sustainable urban development practices.

The strength-duration curves for left bundle branch area pacing

BACKGROUND

Despite growing clinical use of left bundle branch pacing (LBBP) there is scarcity of data regarding fundamentals of this pacing modality including chronaxie and rheobase.

OBJECTIVE

The aims of this study were to calculate strength-duration curves with chronaxie, rheobase values for LBBP and left ventricular septal myocardial pacing (LVSP), to analyse battery current drain and presence of selective LBBP at very short pulse duration (PD).

METHODS

The group of 141 patients with permanent LBBP were studied. The LBBP and LVSP capture thresholds were assessed at 6 different PDs to calculate the strength-duration curves. Battery current drain at these PDs and presence of selective LBBP were determined. For comparison of strength-duration curves between His bundle pacing (HBP) and LBBP, source data from our previous work based on 127 patients with HBP were obtained.

RESULTS

The chronaxies for LBBP and LVSP were very similar (0.38 ms vs. 0.39 ms) and the rheobases were identical (0.27V). The chronaxie for LBBP was lower than for HBP (0.38ms vs. 0.53 ms, p < 0.001), whereas rheobases were similar (0.27V vs. 0.26V). A narrow zone of selective capture was present in 19% and 41% of patients at PD of 0.06 ms and 0.03 ms, respectively. When pacing with the safety margin of +1 V, the lowest battery current drain was achieved with PD of 0.2 ms.

CONCLUSION

The obtained strength-duration curves for LBBP and LVSP provide insights for optimal programming of LBBAP devices with regard to pulse duration, voltage amplitude, battery longevity and selective capture.

The occurrence of heavy metals and antimicrobials in sewage sludge and their predicted risk to soil - Is there anything to fear?

The study assessed the occurrence of legally-monitored heavy metals and unmonitored antimicrobials in sludge from small, medium, large and very large municipal wastewater treatment plants (WWTPs), and the predicted environmental risk and risk of resistance selection associated with sludge administration to soil. The temporal variations of the studied compounds in sludge and associated risks to soil were determined by sampling over a year. Although the highest concentrations of heavy metals were noted in sludge from the largest WWTP, i.e. from 1.50 mg/kg (mean 1.61 mg/kg) for Cd to 2188 mg/kg (mean 1332 mg/kg) for Zn, the obtained values only reached a few percent of the legal limits. The same WWTP also demonstrated lower concentrations of antimicrobials compared to the smaller ones. The highest concentrations of antimicrobials, ranging from 24.04 μg/kg for trimethoprim to 900.24 μg/kg for tetracycline, were found in the small and medium WWTPs. However, due to lack of regulations at the national and EU levels, the results cannot be compared with legal limits. Principal Component Analysis (PCA), cluster and heatmap analysis separated samples according to WWTP size. Small WWTP demonstrated correlation with antimicrobials (tetracycline, trimethoprim, clindamycin, ciprofloxacin and ofloxacin), while the large and very large WWTP revealed correlations with heavy metals (Cu and Cr). The obtained environmental risk quotients confirmed that the heavy metals did not present a threat, measured either as individual risk quotients (RQenv), cumulative risk (RQcumulative) or risk of mixture of heavy metals (RQmix-metals). In the case of antimicrobials, only tetracycline demonstrated moderate RQenv, RQcumulative and RQmix-antimicrobials in the small WWTP sludge, with values of 0.1 to 1. Our findings highlight the importance of monitoring sewage sludge before soil application, especially from small WWTPs, to reduce the potential environmental impact of antimicrobials. They also confirm our previous data regarding the environmental risk associated with various toxic compounds, including emerging contaminants, in the sludge from small WWTPs.

Between flood and drought: How cities are facing water surplus and scarcity

Droughts and floods are weather-related hazards affecting cities in all climate zones and causing human deaths and material losses on all inhabited continents. The aim of this article is to review, analyse and discuss in detail the problems faced by urban ecosystems due to water surplus and scarcity, as well as the need of adaptation to climate change taking into account the legislation, current challenges and knowledge gaps. The literature review indicated that urban floods are much more recognised than urban droughts. Amongst floods, flash floods are currently the most challenging, which by their nature are difficult to monitor. Research and adaptation measures related to water-released hazards use cutting-edge technologies for risk assessment, decision support systems, or early warning systems, among others, but in all areas knowledge gaps for urban droughts are evident. Increasing urban retention and introducing Low Impact Development and Nature-based Solutions is a remedy for both droughts and floods in cities. There is the need to integrate flood and drought disaster risk reduction strategies and creating a holistic approach.

Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study

Background

It is a well-known fact that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions. However, there is a poor insight into the cardiovascular involvement and sequelae in patients without preexisting conditions. The aim of the study is to analyse the influence of COVID-19 on cardiac performance in patients without prior history of structural heart disease. The study is part of the CRACoV project, which includes a prospective design and a 12-month follow-up period.

Material and methods

The study included 229 patients hospitalised with a diagnosis of COVID-19 (median age of 59 years, 81 were women). A standard clinical assessment and laboratory tests were performed in all participants. An extended echocardiographic image acquisition was performed at baseline and at a 3-, 6-, and 12-month follow-up. All analyses were performed off-line. A series of echocardiographic parameters was compared using repeated measures or Friedman analysis of variance.

Results

In all subjects, the left ventricular (LV) ejection fraction at baseline was preserved [63.0%; Q1:Q3 (60.0-66.0)]. Elevated levels of high-sensitivity cardiac troponin T were detected in 21.3% of the patients, and elevated NT-proBNP levels were detected in 55.8%. At the 1-year follow-up, no significant changes were observed in the LV diameter and volume (LV 48.0 ± 5.2 vs. 47.8 ± 4.8 mm, p = 0.08), while a significant improvement of the parameters in the biventricular strain was observed (LV -19.1 ± 3.3% vs. -19.7 ± 2.5%, p = 0.01, and right ventricular -19.9 ± 4.5% vs. -23.2 ± 4.9%, p = 0.002). In addition, a decrease in the LV wall thickness was also observed (interventricular septum 10.4 ± 1.6 vs. 9.7 ± 2.0 mm, p < 0.001; LV posterior wall 9.8 ± 1.4 vs. 9.1 ± 1.5 mm, p < 0.001).

Conclusions

In an acute phase of COVID-19, the elevation of cardiac biomarkers in patients with normal left ventricular ejection fraction is a frequent occurrence; however, it does not translate into clinically significant cardiac dysfunction after 1 year. The serial echocardiographic evaluations conducted in patients without preexisting structural heart disease demonstrate an overall trend towards an improved cardiac function and a reduced myocardial thickening at 1-year follow-up. This suggests that the acute cardiac consequences of COVID-19 are associated with systemic inflammation and haemodynamic stress in patients without preexisting conditions.

Left bundle branch area pacing prevents pacing induced cardiomyopathy in long-term observation

BACKGROUND

Left bundle branch area pacing (LBBAP) is one of the methods to deliver conduction system pacing which potentially avoids the negative impact of conventional right ventricular pacing.

OBJECTIVE

To assess echocardiographic outcomes in a long-term observation in patients with LBBAP implemented for bradyarrhythmia indications.

METHODS AND RESULTS

A total of 151 patients with symptomatic bradycardia and LBBAP pacemaker implanted, were prospectively included in the study. Subjects with left bundle branch block and CRT indications (n = 29), ventricular pacing burden <40% (n = 11), and loss of LBBAP (n = 10) were excluded from further analysis. At baseline and the last follow-up visit, echocardiography with global longitudinal strain (GLS) assessment, 12-lead ECG, pacemaker interrogation, and blood level of NT-proBNP were performed. The median follow-up period was 23 months (15.5-28). None of the analyzed patients fulfilled the criteria for pacing induced cardiomyopathy (PICM). Improvement in left ventricular ejection fraction (LVEF) and GLS was observed in patients with LVEF <50% at baseline (n = 39): 41.4 ± 9.2% versus 45.6 ± 9.9%, and 12.9 ± 3.6% versus 15.5 ± 3.7%, respectively. In the subgroup with preserved EF (n = 62), LVEF and GLS remained stable at follow-up: 59.3 ± 5.5% versus 60 ± 5.5%, and 19 ± 3.9% versus 19.4 ± 3.8%, respectively.

CONCLUSION

LBBAP prevents PICM in patients with preserved LVEF and improves left ventricle function in subjects with depressed LVEF. LBBAP might be the preferred pacing modality for bradyarrhythmia indications.

Efficient traceless modification of the P1 bacteriophage genome through homologous recombination with enrichment in double recombinants: A new perspective on the functional annotation of uncharacterized phage genes

The advent of high-throughput omic technologies has caused unprecedented progress in research on bacteriophages, the most abundant and still the least explored entities on earth. Despite the growing number of phage genomes sequenced and the rejuvenation of interest in phage therapy, the progress in the functional analysis of phage genes is slow. Simple and efficient techniques of phage genome targeted mutagenesis that would allow one to knock out particular genes precisely without polar effects in order to study the effect of these knock-outs on phage functions are lacking. Even in the case of model phages, the functions of approximately half of their genes are unknown. P1 is an enterobacterial temperate myophage of clinical significance, which lysogenizes cells as a plasmid. It has a long history of studies, serves as a model in basic research, is a gene transfer vector, and is a source of genetic tools. Its gene products have structural homologs in several other phages. In this perspective article, we describe a simple and efficient procedure of traceless P1 genome modification that could also serve to acquire targeted mutations in the genomes of certain other temperate phages and speed up functional annotations of phage genes.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference

BACKGROUND

During nonselective His bundle (HB) pacing, it is clinically important to confirm His bundle capture versus right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture, left ventricular lateral wall activation time, approximated by the V₆ R-wave peak time (V₆ RWPT), will not be longer than the corresponding activation time during native conduction.

METHODS

Consecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V₆ RWPT and native HB potential-V₆ RWPT. The difference between these two intervals (delta V₆ RWPT), which was diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis.

RESULTS

A total of 723 electrocardiograms (ECGs) (219 with native rhythm, 172 with selective HB, 215 with nonselective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V₆ RWPT, nonselective-, and selective-HB paced V₆ RWPT were nearly equal, while RVS V₆ RWPT was 32.0 (±9.5) ms longer. The ROC curve analysis indicated delta V₆ RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion.

CONCLUSIONS

We validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V₆ RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V₆ RWPT indicates RVS capture.

Comparison of six risk scores for the prediction of atrial fibrillation recurrence after cryoballoon-based ablation and development of a simplified method, the 0-1-2 PL score

INTRODUCTION

There are several prognostic scores for the assessment of risk of atrial fibrillation (AF) recurrence post ablation procedure. However, the use of these complex scores is difficult and the validation on different populations brought divergent results. Our goal was to compare the performance of these risk scores as the basis for the development of a new, simplified score based only on few universally predictive variables.

METHODS

All cryoballoon-based AF ablations performed in a single-center over a 10-year period were prospectively analyzed with regard to AF recurrence. This served to analyze the performance of APPLE, CAAP-AF, SCALE-CryoAF, MB-LATER, CHADS2, and CHA2DS2-VASc risk scores.

RESULTS

A total of 597 patients, mostly (78.1%) with paroxysmal AF were studied. Analyzed risk scores performed poorer than in the original publications because some risk factors were not predictive of AF recurrence. A simplified score named 0-1-2 PL, composed of just two universally predictive variables, AF type (1 point for Persistent AF) and LA dimension (1 point for LA size >45 mm) was developed. The 0-1-2 PL score stratified patients into low risk (0 points), intermediate risk (1 point), and high risk categories (2 points) which were related to a 2-year risk of AF recurrence of 21%, 37%, and 55%, respectively. This score had C-statistics (0.620) higher/comparable to other investigated much more complex scores.

CONCLUSION

The assessment of risk of AF recurrence at the pre-ablation stage can be simplified without compromising accuracy. This could help to popularize risk assessment and standardization of AF management.

The V6-V1 interpeak interval: a novel criterion for the diagnosis of left bundle branch capture

AIMS

We hypothesized that during left bundle branch (LBB) area pacing, the various possible combinations of direct capture/non-capture of the septal myocardium and the LBB result in distinct patterns of right and left ventricular activation. This could translate into different combinations of R-wave peak time (RWPT) in V1 and V6. Consequently, the V6-V1 interpeak interval could differentiate the three types of LBB area capture: non-selective (ns-)LBB, selective (s-)LBB, and left ventricular septal (LVS).

METHODS AND RESULTS

Patients with unquestionable evidence of LBB capture were included. The V6-V1 interpeak interval, V6RWPT, and V1RWPT were compared between different types of LBB area capture. A total of 468 patients from two centres were screened, with 124 patients (239 electrocardiograms) included in the analysis. Loss of LVS capture resulted in an increase in V1RWPT by ≥15 ms but did not impact V6RWPT. Loss of LBB capture resulted in an increase in V6RWPT by ≥15 ms but only minimally influenced V1RWPT. Consequently, the V6-V1 interval was longest during s-LBB capture (62.3 ± 21.4 ms), intermediate during ns-LBB capture (41.3 ± 14.0 ms), and shortest during LVS capture (26.5 ± 8.6 ms). The optimal value of the V6-V1 interval value for the differentiation between ns-LBB and LVS capture was 33 ms (area under the receiver operating characteristic curve of 84.7%). A specificity of 100% for the diagnosis of LBB capture was obtained with a cut-off value of >44 ms.

CONCLUSION

The V6-V1 interpeak interval is a promising novel criterion for the diagnosis of LBB area capture.

Deep septal deployment of a thin, lumenless pacing lead: a translational cadaver simulation study

AIMS

The recently introduced technique of direct transseptal pacing of the left bundle branch is poorly characterized with many questions with regard to the optimal implantation strategy and safety concerns largely left unanswered. We developed a cadaver model for deep septal lead deployment in order to investigate the depth of penetration in relation to lead behaviour, lead tip position, and the number of rotations.

METHODS AND RESULTS

Five fresh human hearts and five lumenless, 4.1-Fr pacing leads were used for deep septal deployment simulations. The leads were positioned with the use of a dedicated delivery sheath and screwed into the interventricular septum at several sites progressively more distal from the atrioventricular ring with a predetermined number of lead rotations. During each lead deployment, the depth of tip penetration was measured and the lead behaviour was noted. Four distinct lead behaviours were observed: (i) helix only penetration, no matter how many rotations were performed, due to the 'endocardial entanglement effect' (43.1% cases) or (ii) 'endocardial barrier effect' (19.6% cases), (iii) shallow/moderate penetration, with ensuing 'drill effect' when more rotations were added (9.8% cases), and (iv) deep progressive penetration with each additional rotation, occurring when the 'screwdriver effect' was present (27.4% cases, including three septal perforations). These different lead behaviours seemed to be determined by the lead position-mainly the strength of the initial endocardial layer-and the number of fully transmitted rotations.

CONCLUSION

New insights into deep septal lead deployment technique were gained with regard to safe and successful implantation.

Physiology-based electrocardiographic criteria for left bundle branch capture

BACKGROUND

During left bundle branch (LBB) area pacing, it is important to confirm that capture of the LBB, and not just capture of only adjacent left ventricular (LV) myocardium, has been achieved.

OBJECTIVE

The purpose of this study was to establish electrocardiographic (ECG) criteria for LBB capture. We hypothesized that because LBB pacing results in physiological depolarization of the LV, then the native QRS can serve as a reference for diagnosis of LBB capture in the same patient.

METHODS

Only patients with evidence of LBB capture (QRS morphology transition) were included. Several QRS characteristics were compared between the native rhythm and different types of LBB area capture.

RESULTS

A total of 357 ECGs (124 patients) were analyzed: 118 with native rhythm, 124 with nonselective LBB capture, 69 with selective LBB capture, and 46 with LV septal capture. Our hypotheses that during LBB capture the paced V6 R-wave peak time (RWPT; measured from QRS onset) equals the native V6 RWPT and that the paced V6 RWPT (measured from the stimulus) equals the LBB potential to V6 R-wave peak interval were positively validated. Criteria based on these rules had sensitivity and specificity of 88.2%-98.0% and 85.7%-95.4%, respectively. Moreover, 100% specific V6 RWPT cutoff for LBB capture diagnosis in patients with narrow QRS/right bundle branch block was determined to be 74 ms.

CONCLUSION

We showed equivalency of LV activation times on ECG during native and paced LBB conduction. Therefore, if V6 RWPT is longer during pacing, this finding is indicative of lack of LBB capture.

Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

BACKGROUND

Transesophageal echocardiography (TEE) allows detailed characterization of atrial fibrillation (AF) substrate and could be valuable for predicting pulmonary vein isolation (PVI) procedure outcomes.

AIMS

We aimed to assess the value of TEE-derived left atrial (LA) and LA appendage (LAA) features as prognostic markers for AF recurrence after cryoballoon-based ablation.

METHODS

Patients were enrolled using prospective database of consecutive PVI procedures performed over a 7-year period. Following TEE-derived parameters were investigated: LAA emptying flow velocity (LAA-FV), presence of patent foramen ovale (PFO), LA spontaneous echo contrast and mitral regurgitation. Diagnosis of AF recurrence was based on scheduled and symptoms triggered ECG monitoring. Cox's regression model and Kaplan-Meier survival curves were applied for statistical analysis.

RESULTS

A total of 417 consecutive patients who underwent their first PVI using cryoballoon were analysed (mean age: 59 years). AF recurrence was noted in 25.7 % of patients (median follow-up of 24 months). Four TEE-derived variables had predictive value for AF recurrence: LAA-FV < 45 cm/s, presence of PFO at resting state, LA spontaneous echo contrast and mitral regurgitation. In the multivariable model, apart from the transthoracic echocardiography-derived LA size, two TEE-derived features (LAA-FV < 45 cm/s and presence of PFO) remained as independent predictors.

CONCLUSIONS

This study proposed a novel TEE-derived AF recurrence risk factor - presence of PFO and confirmed the prognostic value of LAA flow velocity in patients undergoing cryoballoon-based AF ablation. These risk factors could be useful in global assessment of AF recurrence risk and potentially helpful in planning the ablation strategy.

Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

BACKGROUND

Transesophageal echocardiography (TEE) allows detailed characterization of atrial fibrillation (AF) substrate and could be valuable for predicting pulmonary vein isolation (PVI) procedure outcomes.

AIMS

We aimed at assessing the value of TEE-derived left atrial (LA) and LA appendage (LAA) features as prognostic markers for AF recurrence after cryoballoon-based ablation.

METHODS

Patients were enrolled using a prospective database of consecutive PVI procedures performed over a 7-year period. The following TEE-derived parameters were investigated: LAA emptying flow velocity (LAA-FV), the presence of patent foramen ovale (PFO), LA spontaneous echo contrast, and mitral regurgitation. Diagnosis of AF recurrence was based on scheduled and symptoms triggered ECG monitoring. The Cox's regression model and Kaplan-Meier survival curves were applied for statistical analysis.

RESULTS

A total of 417 consecutive patients who underwent their first PVI using cryoballoon were analyzed (mean age: 59 years). AF recurrence was noted in 25.7% of patients (median follow-up of 24 months). Four TEE-derived variables had predictive values for AF recurrence: LAA-FV <45 cm/s, presence of PFO at resting state, LA spontaneous echo contrast, and mitral regurgitation. In the multivariable model, apart from the transthoracic echocardiography-derived LA size, two TEE-derived features (LAA-FV <45 cm/s and the presence of PFO) remained as independent predictors.

CONCLUSIONS

This study proposed a novel TEE-derived AF recurrence risk factor - the presence of PFO - and confirmed the prognostic value of LAA flow velocity in patients undergoing cryoballoon-based AF ablation. These risk factors could be useful in the global assessment of AF recurrence risk and potentially helpful in planning the ablation strategy.

Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation

BACKGROUND

One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation.

OBJECTIVE

The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsR' morphology in lead V₁ (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.

METHODS

Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.

RESULTS

A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P <.001). Sensitivity, specificity, and positive and negative predictive values of the fixation beats as a marker for reaching the LBB area were 96.4%, 97.3%, 97.3%, and 96.5%, respectively. In the prospective, fixation beats-guided implantation phase, fixation beats were observed in all patients and only at the LBB capture depth.

CONCLUSION

Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.

Electrocardiographic characterization of non-selective His-bundle pacing: validation of novel diagnostic criteria

AIMS

Permanent His-bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium-this is described as a non-selective (ns)-HB pacing. It is of clinical importance to confirm HB capture using standard electrocardiogram (ECG). Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing.

METHODS AND RESULTS

Patients with permanent HB pacing were recruited. Electrocardiograms during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. Electrocardiogram criteria for loss/presence of HB capture were identified. In the validation phase, these criteria and the 'HB ECG algorithm' were tested using a separate, sizable set of ECGs. A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time (RWPT) in lead V6 were identified as the best features for differentiation. The 'HB ECG algorithm' based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. The criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in Leads I, V1, V4-V6, and the V6 RWPT ≤ 100 ms) presented 100% specificity.

CONCLUSION

A novel ECG algorithm for the diagnosis of loss of HB capture and criteria for definitive confirmation of HB capture were formulated and validated. The algorithm might be useful during follow-up and the criteria for definitive confirmation of ns-HB capture offer a simple and reliable ancillary procedural endpoint during HB device implantation.

Programmed deep septal stimulation: A novel maneuver for the diagnosis of left bundle branch capture during permanent pacing

INTRODUCTION

Permanent deep septal stimulation with capture of the left bundle branch (LBB) enables maintenance/restoration of the physiological activation of the left ventricle. However, it is almost always accompanied by the simultaneous engagement of the local septal myocardium, resulting in a fused (nonselective) QRS complex, therefore, confirmation of LBB capture remains difficult.

METHODS

We hypothesized that programmed extrastimulus technique can differentiate nonselective LBB capture from myocardial-only capture as the effective refractory period (ERP) of the myocardium is different from the ERP of the LBB. Consecutive patients undergoing pacemaker implantation underwent programmed stimulation delivered from the lead implanted in a deep septal position. Responses to programmed stimulation were categorized on the basis of sudden change in the QRS morphology of the extrastimuli, observed when ERP of LBB or myocardium was encroached upon, as: "myocardial," "selective LBB," or nondiagnostic (unequivocal change of QRS morphology).

RESULTS

Programmed deep septal stimulation was performed 269 times in 143 patients; in every patient with the use of a basic drive train of 600 milliseconds and in 126 patients also during intrinsic rhythm. The average septal-myocardial refractory period was shorter than the LBB refractory period: 263.0 ± 34.4 vs 318.0 ± 37.4 milliseconds. Responses diagnostic for LBB capture ("myocardial" or "selective LBB") were observed in 114 (79.7%) of patients.

CONCLUSIONS

A novel maneuver for the confirmation of LBB capture during deep septal stimulation was developed and found to enable definitive diagnosis by visualization of both components of the paced QRS complex: selective paced LBB QRS and myocardial-only paced QRS.

P1723 Spectacular left ventricle post infarction aneurysm

Sixty six-y.o. woman 2 months after anterior wall ST-segment elevation myocardial infraction and PCI LAD + 3DES (TIMI 1) was re-admitted to the clinic because of progressive severe heart failure (NYHA III/IV). In admission NT-proBNP level was 14 000 pg/ml, INR 1,7, bilirubin 4,5mg/dl. The electrocardiogram showed persistent ST elevation on anterior leads. Transthoracic echocardiography (TTE) revealed spectacular finding: aneurysm of left ventricle (LV) involving ½ distal part of interventricular septum, apex, inferior, anterior and lateral wall with LVEF 24%, LVEDV 272ml. Thickness of intraventricular septum (IVS) on aneurysm level was only 2,5-3,5mm. In the middle part of IVS a minimal ventricular septal defect (VSD) was showed. Cardiac magnetic resonance examination confirmed TTE findings. The course of the disease was dynamic. The diameter of VSD was increased during consecutive days of hospitalization with maximum width 6,5mm. The patient was hemodynamical unstable, she needed pressure amines, diuretics and intra-aortic balloon pumping. The patient underwent several Heart Team consultations. She was disqualified from percutaneous VSD closing because of thickness of IVS and spiral shape of VSD. Due to potentially too small LV volume after LV plastic surgery the patient was also disqualified from that procedure. We reported the patient to heart transplantation (HTX). There was no transplant donor. In next days we observed progressive signs of a cardiogenic shock with right ventricle decompensation secondary to widening of VSD. Because of unstable stage and growing decompensation, no possibility of HTX patient had life—saving cardiac surgery of LV with mitral valve and tricuspid valve anuloplasthies. The patient survived operation.

Abstract P1723 Figure.

Programmed His Bundle Pacing: A Novel Maneuver for the Diagnosis of His Bundle Capture

BACKGROUND

During permanent nonselective His bundle (ns-HB) pacing, it is crucial to confirm HB capture/exclude that only right ventricle (RV) myocardial septal pacing is present. Because the effective refractory period (ERP) of the working myocardium is different than the ERP of the HB, we hypothesized that it should be possible to differentiate ns-HB capture from RV myocardial capture using programmed extrastimulus technique.

METHODS

In consecutive patients during HB pacemaker implantation, programmed HB pacing was delivered from the screwed-in HB pacing lead. Premature beats were introduced at 10-ms steps during intrinsic rhythm and also after a drive train of 600 ms. The longest coupling interval that resulted in an abrupt change of QRS morphology was considered equal to ERP of HB or RV myocardium.

RESULTS

Programmed HB pacing was performed from 50 different sites in 32 patients. In 34 of 36 cases of ns-HB pacing, the RV myocardial ERP was shorter than HB ERP (271.8±38 versus 353.0±30 ms; P<0.0001). Programmed HB pacing using a drive train resulted in a typical abrupt change of paced QRS morphology: from ns-HB to RV myocardial QRS (34 of 36 cases) or to selective HB QRS (2 of 36 cases). Programmed HB pacing delivered during native conduction resulted in obtaining selective HB QRS in 20 of 34 and RV myocardial QRS in 14 of 34 of the ns-HB cases. In RV myocardial-only pacing cases (false ns-HB pacing, n=14), such responses were not observed-the QRS morphology remained stable. Therefore, the programmed HB pacing correctly diagnosed all ns-HB cases and all RV myocardial pacing cases.

CONCLUSIONS

A novel maneuver for the diagnosis of HB capture, based on the differences in ERP between HB and myocardium, was formulated, assessed, and found as diagnostically valuable. This method is unique in enabling to visualize selective HB QRS in patients with otherwise obligatory ns-HB pacing (RV myocardial capture threshold <HB capture threshold).

P6019His-Purkinje system pacing in single centre experience after 324 cases

Introduction

His-Purkinje system pacing preserves or restores physiologic depolarization of the left ventricle during permanent pacing. It consists of two complementary techniques: His bundle pacing (HB-P) and the recently introduced left bundle branch pacing (LBB-P). There is limited data on HB-P outcomes and only a few reports of LBB-P results.

Purpose

Our aim was to investigate success rate, complications, acute and early pacing parameters in patients undergoing HB-P and LBB-P in the setting of a cardiology tertiary centre that routinely implants HB-P and LBB-P pacemakers.

Methods

On the basis of a prospective database we performed a longitudinal cohort study of all consecutive patients with His-Purkinje system devices implanted in the years 2014–2019. In all cases, model 3830 lumen-less 4.1 Fr pacing lead was used. HB-P was achieved via HB mapping or pace mapping, LBB-P was achieved via deep septal lead deployment under electrophysiological and 12-lead ECG guidance.

Results

Since 2014 there were 324 implantations of His-Purkinje system pacemakers. Baseline patients' characteristics are presented in Table. The overall success rate was 81.5%. Selective HB-P, non-selective HB-P and LBB-P were achieved in 53%, 19% and 28% of successful cases. The mean fluoroscopy time was 11±9 min. The lead delivery was performed using single sheath (C315His) in 83% cases, while in 17% extra steerable sheath was necessary (C304XL). The acute mean LBB-P capture threshold @0.5 ms was significantly lower than in HB-P (0.65±0.43V vs. 1.47±0.8V). The mean chronic LBB-P capture threshold @1.0 ms was also lower than in HB-P (0.45±0.3V vs. 0.95±0.7V, p<0.001). The acute sensing amplitude was significantly higher in LBB-P vs HB-P (10±5mV vs 4±3mV). The mean paced QRS duration was significantly shorter for selective HB-P (113±22 ms) and LBB-P (108±12 ms) vs. non-selective HB-P (132±22 ms). The complications included: 4 cases of threshold increase that required lead revision; 3 early lead dislodgments; 1 loss of LBB capture, 3 pocket hematomas, 2 system infections and 1 pneumothorax.

Baseline characteristics Age; sex 73±12 years (19–95 years); 64% males Mean EF; mean QRS duration; Presence of heart failuire or ischemic heart disease 47±15%; 128±32 ms; 48%; 37.5% Pacing indication AV block 31%; sinus node disease 12%; atrial fibrillation with bradycardia 37%; CRT 20% QRS morphology narrow QRS 61%; LBBB 20%; other 14%; IVCD 6% CRT, Cardiac Resynchronization Therapy; IVCD, Interventricular Conduction Delay.

Conclusion

His-Purkinje system pacing in routine practice has an acceptable success rate, pacing parameters and complication rate; the LBB-P provides better pacing parameters than HB-P. We believe that such single-centre experience paves the way for a large randomized trial of physiologic pacing.

Comprehensive approach to restoring urban recreational reservoirs. Part 2 - Use of zooplankton as indicators for the ecological quality assessment

The presented research is part of the LIFE project ("EH-REK" LIFE08 ENV/PL/000517) on innovative restoration methods for small urban impoundments in the city of Łódź (Poland). The objective was to evaluate the usefulness of zooplankton as a biological quality element, when assessing the effectiveness of restoration efforts in three urban reservoirs and a one pond. The fifth unrestored pond was used as an example of the progressive eutrophication of an urban ecosystem. Studies were conducted during two periods: before (2010-2012) and after (2013-2016) restoration. A selection of zooplankton indices, including the rotifer trophic state index (TSI_ROT), was used. The influence of the supplying river resulted in the negligible responses of biological parameters to the restoration efforts in the Upper Arturówek (UA) reservoir, which is the first in cascade of reservoirs. However, clear symptoms of water quality improvements were observed in the other two reservoirs (the Middle Arturówek, MA; the Lower Arturówek, LA) and in the Bzura-17 (B17) pond. After restoration, the contribution of species indicative of high trophic levels decreased in these ecosystems. The TSI_ROT was strongly positively correlated with the trophic state index based on chlorophyll a, and both parameters significantly decreased in the MA, LA and B17. In the unrestored pond (B11), the successive increase in the concentrations of chemical parameters indicated progressing eutrophication. Interestingly, since 2013, the TSI_ROT values clearly decreased in B11, but the strong negative correlation between ammonium concentration and rotifer density indicated that the reduced TSI_ROT values didn't result from improvements in water quality; rather, they resulted from the increases in pollution and the associated harmful impacts on Rotifera. In conclusion, the TSI_ROT can be a useful tool for assessing the ecological quality of small urban ecosystems; however, the use of biological indices must be supported by also monitoring physicochemical parameters.

Restoration of a shady urban pond - The pros and cons

The Bzura-7 pond (Łódź, Poland) is a typical shallow and shady urban reservoir situated on the Bzura River that is exposed to pollutants introduced mainly by internal loads and the supply from the catchment. In 2010-2012, the following characteristics were observed in the pond: a high allochthonous input of organic matter, high concentration of ammonium, low concentration of dissolved oxygen and low diversity of zooplankton, dominated mainly by Daphnia spp. From January to June 2013, restoration measures were performed, including sediment removal, increasing light access to the pond and construction of a sequential sedimentation-biofiltration system (SSBS). The aim of the present study was to investigate how the water quality in the Bzura-7 pond was affected by the restoration process, which included reducing pollutant inflows and enhancing habitat potential, thus increasing the diversity of this ecosystem. Restoration efforts improved the chemical and physical parameters of the water. The oxygen concentration increased, and the concentrations of TN and ammonium significantly decreased. Despite the increase in pond lighting, the growth of cyanobacteria was limited. However, we observed increased abundance of green algae and diatoms but less than adequate changes in the zooplankton community structures. Although we observed a significant increase in the zooplankton species richness after restoration, this increase was related to the small-bodied groups of zooplankton, rotifers and bosminiids, characteristic of eutrophic ecosystems. In addition, a planktivorous fish - sunbleak (Leucaspius delineatus) - was identified as an unintended side effect of the restoration effort. Further conservation efforts in the Bzura-7 pond and monitoring of results are still needed.

Phage Therapy: What Have We Learned?

In this article we explain how current events in the field of phage therapy may positively influence its future development. We discuss the shift in position of the authorities, academia, media, non-governmental organizations, regulatory agencies, patients, and doctors which could enable further advances in the research and application of the therapy. In addition, we discuss methods to obtain optimal phage preparations and suggest the potential of novel applications of phage therapy extending beyond its anti-bacterial action.

Effects of device‑guided slow breathing training on exercise capacity, cardiac function, and respiratory patterns during sleep in male and female patients with chronic heart failure

INTRODUCTION Slow breathing training (SBT) has been proposed as a new nonpharmacologic treatment in patients with chronic heart failure (CHF). OBJECTIVES The aim of this study was to assess the effects of SBT on exercise capacity, hemodynamic parameters, and sleep respiratory patterns in a relatively large sample of CHF patients. PATIENTS AND METHODS A crossover open study was conducted. Patients completed, in a random order, 10- to 12‑week SBT, with 2 15‑minute sessions of device‑guided SBT each day, reaching 6 breaths/ min, and a 10- to 12‑week follow‑up under standard care. Clinical data collection, polysomnography, echocardiography, 6‑minute walk test (6MWT), and laboratory tests were performed. RESULTS A total of 96 patients (74 men, 22 women) in New York Heart Association classes I-III, with an average age of 65 years and an ejection fraction (EF) of 31%, completed the study. Home‑based SBT was safe. After training, EF and 6MWT distance improved (EF: 31.3% ±7.3% vs 32.3% ±7.7%; P = 0.030; 6MWT: 449.9 ±122.7 m vs 468.3 ±121.9 m; P <0.001), and the apnea-hypopnea index decreased (5.6 [interquartile range (IQR), 2.1; 12.8] vs. 5.4 [IQR, 2.0; 10.8]; P = 0.043). CONCLUSIONS SBT improved physical capacity and systolic heart function; it also diminished sleep disturbances. The results support the benefits of SBT as a novel component of cardiorespiratory rehabilitation programs in patients with CHF.

Leaching of PCBs and Nutrients from Soil Fertilized with Municipal Sewage Sludge

Although sewage sludge is a rich source of nutrients for arable farming and soil improvement, it can also be a source of pollutants. The effects of the land application of sludge on the PCB and nutrient content of leachate were investigated using cylindrical 650 mm length columns filled with poor quality soil. Treatments included no fertilization (control), fertilization using a 62.5 t/ha dose (O50) of sewage sludge from the largest Polish Wastewater Treatment Plant, in Lodz, and a 62.5 t/ha dose of sewage sludge mixed with CaO (O50Ca). The leaching of sludge-borne PCBs and nutrients was simulated by the application of distilled water in a quantity reflecting the annual rainfall of 562.5 mm. The obtained results demonstrate that application of sewage sludge and water simulated leaching of the most mobile chemical compounds, nitrate for example, whereas the addition of CaO decreased the average PCB and phosphorus concentrations in comparison to the control and O50 samples.

Correlation between depression and burden observed in informal caregivers of people suffering from dementia with time spent on caregiving and dementia severity

OBJECTIVE

The aim of the study is to compare data on the examined population of informal caregivers of people suffering from dementia with previous studies, as well as to assess the correlation between (i) depression determined on the basis of the Center for Epidemiologic Studies Depression Scale and (ii) caregiver burden measured by means of the Zarit Caregiver Burden Scale and some chosen parameters, such as total time devoted to caregiving, time of caregiving in hours per week and level of dementia severity measured by Global Deterioration Scale.

PATIENTS AND METHODS

41 informal caregivers of people suffering from dementia from different backgrounds were evaluated using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies Depression Scale. Demographic data about the time devoted to caregiving and the number of hours spend on caregiving weekly were gathered. The type of dementia and its stage were registered using the Global Deterioration Scale (GDS). With the aid of the Statistica StatSoft program, mutual correlations between the parameters were measured. The study was conducted within the framework of AAL UnderstAID--a platform that supports and helps to understand and assist caregivers in the care of a relative with dementia. The international project is co-founded by the Joint Programme Ambient Assisted Living (Grant code: ESR-aal 2012 5 107).

RESULTS

No significant correlations between the level of depression severity evaluated in caregivers and the total time of taking care of a demented person or time of caregiving in hours per week were observed. Similarly, no significant correlation between depression severity level and dementia severity level measured on the GDS scale were noted. There was also no significant correlation between Zarit Caregiver Burden Scale scores and the above-mentioned parameters.

CONCLUSIONS

The level of depression among caregivers do not depend on socio-demographic factors.

Should abdominal CT scan be performed routinely prior to CRT insertion?

INTRODUCTION

Cancer appears to be a major noncardiovascular factor affecting morbidity and mortality of heart failure (HF) patients. Risk of developing cancer seems to increase over time. It is well documented that patients with cancer treated with chemiotherapy are at risk of developing HF and therefore they should be screened for HF on regular basis. There is limited data whether the opposite should be done, namely routinely screen each HF patient for cancer.

PURPOSE

We hypothesized that in HF patients cancer might be responsible for some symptoms that are incorrectly diagnose as HF related.

MATERIAL AND METHODS

The data from “Renal Denervation in Patients With Chronic Heart Failure and Resynchronization Therapy” study of 18 patients (22% women) aged 73.2 (±9.1 years) with HF in NYHA Class II-IV and resynchronization pacemaker implanted according to current ESC guideliness at least 6 months earlier were analyzed. Patients had symptoms of heart failure despite optimal HF therapy including pharmacotherapy and CRT. Medical history including current symptoms of HF was taken, patients’ demographics and vital signs were assessed. Diagnostic tests in the study group included echocardiography, abdominal CT scan and laboratory tests.

RESULTS

Only in 5 patients CT scan did not show any abnormalities. Renal cysts were present in 5 patients, adrenal glands adenomas were observed in 3 patients and both changes were present in 1 patient. Tumors suspected of malignancy were diagnosed in 4 patients - 2 had a tumor in adrenal glands, 1 had kidney tumor and 1 had tumors both in kidney and adrenal gland. All patients with malignancy were directed for further oncological evaluation.

CONCLUSION

Considering the complex physiology of HF, there is possibility that some HF related mechanisms might trigger cancer development and presence of cancer may aggrevate the symptoms of HF. One should consider evaluation of HF patients on optimal medical therapy, yet still symptomatic to identify some common forms of cancer.

Blood pressure changes in patients with chronic heart failure undergoing slow breathing training

BACKGROUND

Slow breathing training (SBT) has been proposed as a new non-pharmacological treatment able to induce favorable effects in patients with chronic heart failure (CHF). However, no information is available regarding its effects on orthostatic blood pressure (BP) changes in these patients, an issue of practical relevance given the reported BP-lowering effect of SBT. The aim of this study is to evaluate the influence of SBT on BP and whether SBT induces orthostatic hypotension (OH) or changes in quality of life (QoL) in CHF patients.

METHODS

The analysis was performed as part of an ongoing crossover open trial aimed at assessing the clinical effectiveness of SBT in treated patients with CHF. The patients underwent 10-12 weeks of SBT with the RESPeRATE device and 10-12 week follow-up under usual care. Patients were randomly divided into two groups: group I began with SBT, followed by usual care; group II began with usual care, followed by SBT. Patients undergoing SBT were asked to perform each day two separate 15 min sessions of device-guided SBT at a breathing frequency of 6 breaths/min. In all patients, before the enrollment and after each study phase, clinical data collection and BP measurements in sitting, supine and standing position were performed. OH was defined as a decrease of ≥ 20 mmHg in systolic blood pressure (SBP) or ≥ 10 mmHg in diastolic blood pressure (DBP) within 3 min of standing. QoL was assessed three times at the beginning, and after each phase of the study by the Minnesota Living with Heart Failure (MLHF) questionnaire.

RESULTS

Forty patients (two equal groups) completed the study, with the following baseline characteristics: 32 males/eight females, age 63.3 ± 13.4 years, 25 with ischemic CHF, 37 in New York Heart Association class II and three in class III, left ventricular ejection fraction 30.8 ± 6.7%, mean BP 138.7 ± 16.5/83.1 ± 11.5 mmHg, 23 with arterial hypertension and four with a history of stroke. There were no significant differences between the groups in clinical characteristics, SBP and DBP at rest, while seated and before and after standing up. OH prevalence was low and did not change during the study (10% vs 10%). No significant difference in average SBP and DBP changes secondary to body position were found when comparing the two study phases. Decrease in MLHF score was observed in group I during SBT (p = 0.002), but not in group II.

CONCLUSIONS

Our data indicate that SBT is safe, does not affect the prevalence of OH in CHF patients and shows a non-significant tendency to improve QoL. These results should be confirmed in a larger sample of patients to support the safety of SBT and its possible benefits as a novel component of cardiorespiratory rehabilitation programs in CHF.

24-hour central blood pressure and intermediate cardiovascular phenotypes in untreated subjects

BACKGROUND

Recently, 24-hour monitoring of central systolic blood pressure (SBP) has become available. However, the relation between end-organ damage and the 24-hour central SBP profile and variability has not so far been analyzed. Therefore, the aim of this cross-sectional study was to evaluate the relation between 24-hour central SBP, 24-hour central SBP profile as well as central SBP short-term variability and parameters of cardiac and vascular intermediate phenotypes.

METHODS

The study group consisted of 50 patients with newly diagnosed, untreated hypertension (age 40.4 ± 11.5 years, 35 men) and 50 normotensive subjects (age 38.3 ± 12.0 years, 35 men). Applanation tonometry of the radial artery and the "n-point forward moving average" method were used to determine 24-hour central SBP. Each study participant underwent echocardiography and carotid ultrasonography.

RESULTS

24-hour, daytime, and nighttime central SBP was related to left ventricle end-diastole diameter (p < 0.05), left ventricular mass index (p < 0.001), relative wall thickness (p < 0.05), E/E' ratio (p < 0.01), and left atrium volume (p < 0.01). The nocturnal central SBP fall was not related to any of the mentioned parameters, whereas parameters of short-term variability were related to IMT in hypertensives only (p < 0.05).

CONCLUSIONS

The present study showed that 24-hour central SBP is related to intermediate cardiac phenotypes as assessed by echocardiography whereas short-term central SBP variability is mainly related to vascular phenotype as determined by IMT.

Twenty-four-hour profile of central blood pressure and central-to-peripheral systolic pressure amplification

BACKGROUND

The significant difference in central and peripheral blood pressure (BP) values has only recently been widely recognized. Ambulatory BP monitoring has been shown to have advantages over office BP measurements because ambulatory monitoring can provide important information not available when only office BP is measured. The aim of this study was to assess the 24-hour central systolic pressure (CSP) profile, CSP short-term variability, and 24-hour systolic pressure amplification profile.

METHODS

The study group comprised 50 hypertensive subjects and 50 normotensive subjects. All participants underwent 24-hour peripheral and central pressure monitoring.

RESULTS

CSP was lower than peripheral pressure levels during the day (124.1 ± 15.7 mm Hg vs 133.9 ± 16.3 mm Hg; P < 0.001) and night hours (114.4 ± 14.5 mm Hg vs 121.5 ± 15.2 mm Hg; P < 0.001). The CSP nocturnal fall was lower than the peripheral pressure fall in normotensive subjects as well as in hypertensive subjects. Although 24-hour systolic pressure amplification was similar in subjects with and without hypertension (9.2 ± 3.1 mm Hg and 8.3 ± 2.4 mm Hg; P = NS), it was significantly lower during the night than during the day in both groups. The nocturnal fall in systolic pressure amplification was correlated with the day-night difference in heart rate (r = 0.70; P < 0.001).

CONCLUSIONS

Central pressure differs significantly from peripheral pressure during regular daily activity as well as during night hours. Moreover, it appears that systolic pressure amplification varies throughout the 24-hour period and that the main factor determining nocturnal fall in systolic pressure amplification is nocturnal drop in the heart rate. More studies are required to demonstrate advantage of this novel technique over traditional pressure monitoring in clinical practice.

The management of cancer patients with heart disease

Cardiovascular disease and cancer are the two leading causes of death in the world, therefore a patient may have cancer, but also heart disease. Intensive cancer treatment, including chemotherapy and radiotherapy, improves the prognosis, reduces mortality and lengthens patients' lives but it is also associated with cardiotoxicity. This paper describes cardiovascular risk factors and methods for the estimation of individual risk before initiation of oncology treatment in subjects at high baseline risk of heart disease. We also describe the way of monitoring patients receiving potentially cardiotoxic treatment and the management of congestive heart failure, coronary artery disease and hypertension in these subjects.