Cognitive assessments in patients with implantable cardiac pacemaker

Bradyarrhythmias cause low cerebral blood flow and imbalance of the cerebral autore-gulation, favoring neuronal ischemia and cognitive dysfunction. The main treatment in bradyarrhythmia is pacemaker (PM) implantation, which keeps the heart rate in normal range and increase cardiac output. The present study proposed the cognitive evaluation of PM group patients and a control group (CG), but with similar cardiovascular risk factors. Cognitive assessment has been achieved by applying the Mini-Mental State Examination (MMSE), Clock-Drawing Test (CDT) and Mini Clock for both groups.

P6332Prevalence and prognostic impact of sarcopenia identified according to Asia Working Group for Sarcopenia definition in non-dependent elderly patients with heart failure

Background Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and muscle function. As the population ages, there is a growing worldwide interest in the intersection of sarcopenia and heart failure (HF). However, estimates of the prevalence of sarcopenia in HF vary widely because of difference in diagnostic criteria. Although the Asian Working Group of Sarcopenia (AWGS) has announced a consensus on the diagnostic criteria of sarcopenia in Asian people, the prevalence and prognostic impact of sarcopenia based on AWGS criteria in patients with HF remains unclear. Purpose The aim of this study was to investigate the prevalence and predictive value of sarcopenia identified according to AWGS definition in non-dependent elderly patients with HF. Methods This study was a prospective, single-center cohort study in Japan. We consecutively enrolled 274 patients, aged 65 years or older, hospitalized due to acute HF or acute exacerbation of chronic HF and who were able to walk at least 20 m at discharge. Patients with severe cognitive or psychiatric disorders were excluded. Patients with implantable cardiac pacemaker or cardioverter defibrillator were also excluded because skeletal muscle mass was estimated by using bioimpedance analysis. At hospital discharge, we collected data on age, gender, left ventricular ejection fraction, brain natriuretic peptide, estimate glomerular filtration rate, body mass index and sarcopenia. Sarcopenia was diagnosed according to the AWGS criteria: low skeletal muscle index (<7.0 kg/m2 in men, <5.7 kg/m2 in women) and either slow usual walking speed (<0.8 m/s) or low handgrip strength (<26 kg in men, <17 kg in women). Study outcome was rehospitalization for worsening HF within 180 days after discharge. We assessed the independent association between sarcopenia and HF rehospitalization by using multivariate Cox proportional hazards regression analysis. Results In this study, a total of 199 patents (43.4%) fulfilled sarcopenia criteria at discharge. During follow-up, 57 patients (20.8%) readmitted for HF. Kaplan-Meier survival curves showed that patients with sarcopenia had significantly lower event-free survival than those without sarcopenia (Figure). After adjusting for other prognostic factors, sarcopenia was independently associated with HF rehospitalization (hazard ratio: 2.31, 95% confidence interval: 1.20–4.53). Conclusion Based on AWGS criteria, sarcopenia is highly prevalent even among non-dependent elderly HF patients, and is an independent strong predictor of rehospitalization for worsening HF. AWGS criteria for sarcopenia may be useful for risk prediction in HF.

Review of Cardiac Pacemaker Lead Designs for Computational Models in a VR Environment

An implantable cardiac pacemaker is used to modify and treat irregular heartbeats [1] and invented in 1958 [2]. Devices have no fixation or fixed to the heart wall. No fixation leads lay in the bottom of heart cavities, while fixed leads have tines (passive) or a helix screw (active) to attach to the heart. Lead geometries and material properties vary between companies, with geometric sizing based primarily on the internal mechanics of the lead. Finite element analysis (FEA), computational fluid dynamics (CFD) and bench-top simulations are used to evaluate cardiac leads. These simulations analyze only one lead and struggle to compare and test variations in lead designs. Advanced computational resources can run many computer simulations of anatomical environments, however model complexity increases the time to run each simulation. To address this issue, we present a simplified parameterized design space for cardiac pacemaker leads in the right atrium. This information will be used to run multiple simulations of leads in blood flow, for visualization in a single virtual reality (VR) environment and allow the designer to iterate through many design variations (See Figure 1).