The most commonly used method to assess peripheral oxygen saturation (SpO2) in clinical practice is pulse oximetry. The smartwatch Apple Watch 6 was developed with a new sensor and an app that allows taking on-demand readings of blood oxygen and background readings, day and night. The present study aimed to assess the feasibility and agreement of the Apple Watch 6 compared with a standard SpO2 monitoring system to assess normal and pathological oxygen saturation. We recruited study participants with lung disease or cardiovascular disease and healthy subjects. A total of 265 subjects were screened for enrolment in this study. We observed a strong positive correlation between the smartwatch and the standard commercial device in the evaluation of SpO2 measurements (r = 0.89, p < 0.0001) and HR measurements (r = 0.98, p < 0.0001). A very good concordance was found between SpO2 (bias, −0.2289; SD, 1.66; lower limit, −3.49; and upper limit, 3.04) and HR (bias, −0.1052; SD, 2.93; lower limit, −5.84; and upper limit, 5.63) measured by the smartwatch in comparison with the standard commercial device using Bland–Altman analysis. We observed similar agreements and concordance even in the different subgroups. In conclusion, our study demonstrates that the wearable device used in the present study could be used to assess SpO2 in patients with cardiovascular or lung diseases and in healthy subjects.
Background Atrial fibrillation (AF) is the supra-ventricular tachyarrhythmia mostly encountered in the clinical practice.While appearing silent or with a constellation of symptoms, it confers a 5-fold risk of stroke. Early detection is mandatory to establish the diagnosis and recommend anticoagulation. Besides the arrhythmia recognition through several tools, such as Holter ECG and loop recorders, it has been underlined that cardiac implantable electronic devices with an atrial lead can help in recognizing asymptomatic AF periods, also known as atrial high-rate episodes (AHREs). Materials and Methods 48 patients with AHRE detection at device telemetry checks were enrolled; implanted device were pacemakers (n=31, 64.8%); implantable cardioverter/defibrillators (ICD, n=8, 16.6%); cardiac resynchronization therapy devices with defibrillators (CRT-D, n=9, 18.5%). Male gender was predominant (40 vs. 8), age was > 65years, and mean CHA2DS2VASc was 4.2±2.8. Patients underwent ECG assessment in 6-month intervals (at baseline and during follow-up), MOntreal Cognitive Assessment test, and device interrogation for AHRE of duration >5 minutes and rate >175 beats per minute. Randomization to a direct oral anticoagulant (DOAC) or usual care (aspirin when needed or placebo) was provided in a blind fashion and maintained for the entire study observation until occurrence of overt AF, followed by exclusion from the study. Results We found that 13%-16% of patients with device-detected AHRE developed AF over a mean follow-up of 2.5 year (range 4.6±2.0). These cases were given oral anticoagulation since change of indication according to current guidelines. Most important comorbidities were coronary artery disease (n=18 patients, 36.73%); systemic hypertension (n=41, 83.67%); diabetes (n=13, 26.53%); dyslipidemia (n=23, 46.8%); heart failure (n=17, 35.4%). 30 patients were treated with beta-blockers(62.5%). 2 patients died for gastrointestinal bleeding. One patient was excluded for major bleeding after one month from the enrollment. Total AHREs duration was significantly lower in patients with pacemaker (14 hrs) compared to patients with CRT-D (17 hrs) and ICD (20 hrs, p<0.05). Conclusions The impact of AHREs was higher in patients affected by cardiac dysfunction and concomitant diseases; none of the patients enrolled in the study developed ischemic stroke; major bleedings were observed in both arms. Further studies are warranted for considering oral anticoagulation based on the sole device interrogation in the context of subclinical atrial fibrillation.
Background echocardiography is a helpful tool in patients with suspected pulmonary hypertension (PH). Data derived from echocardiographic examination allow to assign a level of probability of PH by using multiple parameters. Nevertheless, the gold standard for the diagnosis of PH remains the right heart catheterization. The evaluation of PH is important in patients undergoing transcatheter tricuspid valve repair, in fact, many trials excluded those with “severe” pulmonary hypertension. Aim the aim of this study was to examine, in the evaluation of PH, the parameters derived from echocardiographic estimation and cardiac catheterization in patients undergoing TriClip implantation. Methods a retrospective analysis of 4 patients underwent to TriClip implantation in our department was performed. Echocardiography and right heart catheterization data were collected. In the assessment of pulmonary hypertension, the analyzed echocardiographic parameters were: enlarged right ventricle in parasternal long-axis view (>30 mm), flattened interventricular septum leading to “D-shaped LV”, dilated inferior vena cava (>21 mm) with diminished inspiratory collapsibility (<50%), RVOT acceleration time of pulmonary ejection <105 msec, reduced right ventricular fractional area change (<35%), decreased tricuspid annular plane systolic excursion (TAPSE <18mm), TAPSE/sPAP ratio <0.55 mm/mmHg, enlarged right atrial area (>18 cm2), increased systolic peak tricuspid regurgitation velocity (peak TRV>2.8 m/s), estimated systolic pulmonary artery pressure (sPAP). Echocardiographic probability of pulmonary hypertension was defined as high: peak TRV >3.4 m/s or a peak TRV between 2.9-3.4 m/s and the presence of other echo PH sign; intermediate: peak TRV between 2.9-3.4 or peak TRV ≤2.8 m/sec with other echo PH signs; low: peak TRV ≤2.8 m/sec. Pulmonary hypertension, in accordance with guidelines, was defined by a mean pulmonary arterial pressure (mPAP)>20 mmHg at rest. Results the echocardiographic probability of pulmonary hypertension was high in three patients: 2 patients had a peak TRV>3.4 m/s, one patient had peak TRV 2.95 with RVOT AT 55, flattened interventricular septum, dilated inferior vena cava with diminished inspiratory collapsibility, right atrium area >18cm2. In one patient the probability was intermediate (peak TRV 2.40 m/s, RA area >18 cm2 and TAPSE/sPAP ratio <0.55 mm/mmHg). Right heart catheterization confirmed the diagnosis of pulmonary hypertension in two patients with high echocardiographic probability. In the other two patients (one with high probability and one with intermediate probability) there was no PH diagnosis at right heart catheterization. Conclusion in only two out of four patients with intermediate-high probability of PH the diagnosis was confirmed by right catheterization. Therefore, invasive evaluation of pulmonary pressures should be performed in patients with severe tricuspid regurgitation undergoing Triclip implantation.
Background The most commonly used method to assess peripheral oxygen saturation (SpO2) in clinical practice is pulse oximetry. Smartwatches are widespread and are increasingly being used for digital health information. The smartwatch Apple Watch 6 was developed with a new sensor and an app that allows taking on-demand readings of blood oxygen and background readings, day and night. Aims The primary aim of the study was the head-to-head comparison of the measurements of SpO2 and heart rate (HR) by the smartwatch and the standard pulse oximeter. The secondary aim was the comparison of the measurements of SpO2 and HR between subgroups (lung disease, cardiovascular disease, healthy subjects). Methods and results We enrolled study participants with lung or cardiovascular disease and healthy subjects. A total of 265 subjects were screened for enrollment in this study. After screening, 257 subjects were included in the present study. The measurements of SpO2 and HR were obtained with the Apple Watch 6 and the Nellcor system and taken within 1 minute of each other in order to ensure comparability between the two devices. The correlation between the two technologies was assessed using linear regression and estimated with Pearson analysis for normally distributed data and Spearman analysis for nonparametric data. A plot of the differences between techniques was created according to the method described by J.M. Bland and D.G. Altmann. We observed a strong positive correlation between the smartwatch and the standard commercial device in the evaluation of SpO2 measurements (r=0.89, p< 0.0001; Figure 1A) and HR measurements (r=0.98, p< 0.0001; Figure 1B). A very good concordance was found between SpO2 (bias, -0.2289; SD, 1.66; lower limit, -3.49; and upper limit, 3.04; Figure 2A) and HR (bias, -0.1052; SD, 2.93; lower limit, -5.84; and upper limit, 5.63; Figure 2B) measured by the smartwatch in comparison with the standard commercial device using Bland–Altman analysis. We observed similar agreements and concordance even in the different subgroups. Conclusions In conclusion, our study demonstrates the feasibility and agreement of the Apple Watch 6 compared with the standard device used to assess SpO2 in patients with cardiovascular or lung diseases and in healthy subjects.
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