The fifth takotsubo variant

We document the fifth pattern of takotsubo cardiomyopathy, in which the mid‐LV is hyperdynamic but the apex and base are akinetic or hypokinetic. This is a reverse mid‐ventricular takotsubo. The patient is a 79‐year‐old woman admitted with chest pain and initially a normal EKG. Her troponin I rose to 5.4 μg/L (0.02‐0.03 μg/L) and she developed QT prolongation and widespread T‐wave inversion. Coronary angiography showed only very mild atheroma. Follow‐up echocardiogram six weeks later showed normal left ventricular function.     

Efficacy and Feasibility of a Tele-health Intervention for Acute Coronary Syndrome Patients with Depression: Results of the “MoodCare” Randomized Controlled Trial

Background

Depression is common after a cardiac event, yet there remain few approaches to management that are both effective and scalable.

Purpose

We aimed to evaluate the 6-month efficacy and feasibility of a tele-health program (MoodCare) that integrates depression management into a cardiovascular disease risk reduction program for acute coronary syndrome patients with low mood.

Methods

A two-arm, parallel, randomized design was used comprising 121 patients admitted to one of six hospitals for acute coronary syndrome.

Results

Significant treatment effects were observed for Patient Health Questionnaire 9 (PHQ9) depression (mean difference [change]?=??1.8; p?=?0.025; effect size: d?=?0.36) for the overall sample, when compared with usual medical care. Results were more pronounced effects for those with a history of depression (mean difference [change]?=??2.7; p?=?0.043; effect size: d?=?0.65).

Conclusions

MoodCare was effective for improving depression in acute coronary syndrome patients, producing effect sizes exceeding those of some face-to-face psychotherapeutic interventions and pharmacotherapy. (Trial Registration Number: ACTRN1260900038623.)     

The sensitivity of 38 heart rate variability measures to the addition of artifact in human and artificial 24‐hr cardiac recordings

Background

Artifact is common in cardiac RR interval data derived from 24‐hr recordings and has a significant impact on heart rate variability (HRV) measures. However, the relative impact of progressively added artifact on a large group of commonly used HRV measures has not been assessed. This study compared the relative sensitivity of 38 commonly used HRV measures to artifact to determine which measures show the most change with increasing increments of artifact. A secondary aim was to ascertain whether short‐term and long‐term HRV measures, as groups, share similarities in their sensitivity to artifact.

Methods

Up to 10% of artifact was added to 20 artificial RR (ARR) files and 20 human cardiac recordings, which had been assessed for artifact by a cardiac technician. The added artifact simulated deletion of RR intervals and insertion of individual short RR intervals. Thirty‐eight HRV measures were calculated for each file. Regression analysis was used to rank the HRV measures according to their sensitivity to artifact as determined by the magnitude of slope.

Results

RMSSD, SDANN, SDNN, RR triangular index and TINN, normalized power and relative power linear measures, and most nonlinear methods examined are most robust to artifact.

Conclusion

Short‐term time domain HRV measures are more sensitive to added artifact than long‐term measures. Absolute power frequency domain measures across all frequency bands are more sensitive than normalized and relative frequency domain measures. Most nonlinear HRV measures assessed were relatively robust to added artifact, with Poincare plot SD1 being most sensitive.