Showing papers by "Andrea Mortara published in 2003"
TL;DR: Reduced short-term LFP during controlled breathing is a powerful predictor of sudden death in patients with CHF that is independent of many other variables, and refine the identification of patients who may benefit from prophylactic implantation of a cardiac defibrillator.
Abstract: Background—The predictive value of heart rate variability (HRV) in chronic heart failure (CHF) has never been tested in a comprehensive multivariate model using short-term laboratory recordings designed to avoid the confounding effects of respiration and behavioral factors. Methods and Results—A multivariate survival model for the identification of sudden (presumably arrhythmic) death was developed with data from 202 consecutive patients referred between 1991 and 1995 with moderate to severe CHF (age 529 years, left ventricular ejection fraction 247%, New York Heart Association class 2.30.7; the derivation sample). Time- and frequency-domain HRV parameters obtained from an 8 recording of ECG at baseline and during controlled breathing (12 to 15 breaths/min) were challenged against clinical and functional parameters. This model was then validated in 242 consecutive patients referred between 1996 and 2001 (validation sample). In the derivation sample, sudden death was independently predicted by a model that included low-frequency power (LFP) of HRV during controlled breathing 13 ms 2 and left ventricular end-diastolic diameter 77 mm (relative risk [RR] 3.7, 95% CI 1.5 to 9.3, and RR 2.6, 95% CI 1.0 to 6.3, respectively). The derivation model was also a significant predictor in the validation sample (P0.04). In the validation sample, LFP 11 ms 2 during controlled breathing and 83 ventricular premature contractions per hour on Holter monitoring were both independent predictors of sudden death (RR 3.0, 95% CI 1.2 to 7.6, and RR 3.7, 95% CI 1.5 to 9.0, respectively). Conclusions—Reduced short-term LFP during controlled breathing is a powerful predictor of sudden death in patients with CHF that is independent of many other variables. These results refine the identification of patients who may benefit from prophylactic implantation of a cardiac defibrillator. (Circulation. 2003;107:565-570.)
847 citations
TL;DR: CHF patients had a higher diaphragm pressure time product per minute than controls when sitting, and assuming a supine position induced severe dyspnea, a large rise in R,L, and a reduction in C,L so that PTPdi/min increased further.
29 citations
01 Dec 2003
TL;DR: The HHH (home or hospital in heart failure) study is a European Community multicenter trial aimed at assessing in a population of chronic heart failure patients 3 incremental home telemonitoring strategies against usual clinical practice.
Abstract: The HHH (home or hospital in heart failure) study is a European Community multicenter trial aimed at assessing in a population of chronic heart failure patients 3 incremental home telemonitoring strategies against usual clinical practice. End points are rehospitalization, quality of life, mortality and cost-efficacy. Easy accessibility by the patient and low management costs are the two basic criteria that have guided the design of the architecture of the HHH telemonitoring system. Voice messages, vital signs and long-term cardiorespiratory data are periodically transmitted by the patients at home to a centralized interactive voice response system shared by several hospitals. From there, relevant data are automatically routed to the pertaining medical staff. The HHH technical infrastructure has been completed and tested in the 3 countries involved in the study and enrolment is in progress. Preliminary results on the feasibility of the HHH telemonitoring model are available.
20 citations
01 Dec 2003
TL;DR: Preliminary results from 24 CHF patients enrolled so far indicate that monthly home telemonitoring is feasible and the compliance is high, and a novel low-cost system for 24-hour recording of cardiorespiratory signals is tested, suitable to be self-managed by the patient at home.
Abstract: Nocturnal respiratory disorders and depressed heart rate variability are known predictors of poor prognosis in chronic heart failure (CHF) patients. Intermittent monitoring of cardiorespiratory signals while the patient is at home might thus allow early identification of clinical deterioration and prompt optimization of treatment, leading to reduced hospitalizations and mortality and improved quality of life. Within the European Community multicenter trial HHH (Home or Hospital in Heart Failure), we are testing a novel low-cost system for 24-hour recording of cardiorespiratory signals, suitable to be self-managed by the patient at home, with transmission of acquired data through standard telephone lines to the medical/nursing staff. Preliminary results from 24 CHF patients enrolled so far indicate that monthly home telemonitoring is feasible and the compliance is high.
12 citations
20 Oct 2003
TL;DR: This study will evaluate in the home setting a new system for long-term noninvasive cardiorespiratory monitoring, suitable to be self-managed by the patient, with transmission of acquired data through standard telephone lines.
Abstract: HHH (Home or Hospital in Heart failure) is an ongoing European Community multicountry study aimed at assessing 3 incremental home telemonitoring strategies against usual clinical practice in relation to rehospitalization, quality of life, mortality and cost-utility. Besides monitoring vital signs by means of an automatic interactive voice response system, this study will evaluate in the home setting a new system for long-term noninvasive cardiorespiratory monitoring, suitable to be self-managed by the patient, with transmission of acquired data through standard telephone lines.
4 citations