Video-based monitoring technologies enable continuous and contactless monitoring of vital signs. This study evaluates the clinical concordance and determinants of performance of contactless video-based heart and respiratory rate monitoring compared with reference standards in a heterogeneous population of critically ill patients. In this prospective observational study, 35 intensive care unit patients were continuously monitored for 24 h. Video-based heart rate and respiratory rate were compared with the clinical reference standard. Agreement was assessed using Bland–Altman plots, intraclass correlation coefficients (ICC), and error grid analyses. Generalized estimating equations (GEE) identified factors affecting agreement. For heart rate, bias was 2.1 bpm (limits − 33.6 to 37.7), with 81.9
BACKGROUND AND AIMS:Left bundle branch area pacing (LBBAP) promotes physiological synchronous activation of the left ventricle and may be particularly beneficial in patients with atrioventricular block (AVB), but its mortality benefit remains unclear. This study aims to compare long-term survival in AVB patients receiving either LBBAP or right ventricular pacing (RVP) and to analyse predictors of mortality during LBBAP. METHODS:MELOS RELOADED, a multicentre European collaboration, was a registry-based study of pacemaker patients with AVB, left ventricular ejection fraction (LVEF) >40% and ventricular pacing >20%. The primary outcome was all-cause mortality based on national registries. A 1:1 propensity score matching was performed between the RVP and LBBAP groups. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to estimate survival. RESULTS:In total, 3382 patients receiving LBBAP or RVP were matched. At 4-year follow-up, the Kaplan-Meier curve showed an absolute difference in survival of 11.8% in favour of LBBAP (P < .001). LBBAP was a robust predictor of reduced mortality with a hazard ratio (HR) of 0.53 (95% confidence interval 0.42-0.65, P < .001). Within the LBBAP group, the following independent predictors of increased mortality were identified: lack of confirmed left bundle branch capture (HR 1.85, P < .001), lower percentage of ventricular pacing (HR 1.12), and age. CONCLUSIONS:This is the first large study demonstrating the long-term survival benefit of LBBAP. This strengthens the use of LBBAP in AVB patients with preserved/mildly reduced LVEF while awaiting the results of randomized trials. Confirmation of left bundle branch capture seems advisable to achieve optimal results with LBBAP.
BACKGROUND:Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) has been associated with increased stent optimization and reduced adverse events among patients with complex coronary-artery lesions, but adoption of this strategy in Western countries remains low. Although practice guidelines recommend intracoronary imaging for anatomically complex lesions, evidence from current European practice is limited. METHODS:In this investigator-initiated, international, open-label, randomized, controlled trial, we assigned patients undergoing complex PCI to either IVUS-guided PCI, performed with the use of prespecified stent-optimization criteria, or angiography-guided PCI. The primary end point was target-vessel failure, defined as a composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-vessel revascularization. RESULTS:Of the 2020 patients who underwent randomization, 1010 in the IVUS-guided PCI group and 1009 in the angiography-guided PCI group were included in the primary analysis. The mean age of the patients was 69 years, 79.4% were men, and 27.4% presented with an acute coronary syndrome. The mean procedure duration was 88.8 minutes with IVUS-guided PCI and 66.2 minutes with angiography-guided PCI. Dilation with balloon angioplasty after stent implantation was performed in 91.3% of the IVUS-guided PCI procedures and in 84.5% of the angiography-guided PCI procedures. At a median follow-up of 19.0 months (interquartile range, 15.2 to 23.4), target-vessel failure had occurred in 140 patients (13.9%) in the IVUS-guided PCI group and in 112 patients (11.1%) in the angiography-guided PCI group (hazard ratio, 1.25; 95% confidence interval, 0.97 to 1.60; P = 0.08). Procedural complications occurred in 11.3% of the IVUS-guided PCI procedures and in 10.2% of the angiography-guided PCI procedures. The frequency of adverse events appeared to be similar in the two groups. CONCLUSIONS:Among patients undergoing complex high-risk PCI, a strategy of routine IVUS-guided PCI performed with the use of prespecified stent-optimization criteria was not associated with a lower risk of target-vessel failure than angiography-guided PCI alone. (Funded by Boston Scientific; IVUS-CHIP ClinicalTrials.gov number, NCT04854070.).
Background Microvascular resistance reserve (MRR) is a novel index for evaluating coronary microvascular function independently of epicardial disease. Its prognostic significance in coronary artery disease (CAD) remains uncertain. Objectives The aim of this study was to assess the association between MRR and adverse cardiovascular outcomes across various CAD presentations. Methods A systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE and Embase were searched from January 2019 to January 2025 for prospective studies reporting HRs for major adverse cardiovascular events in relation to MRR. Risk for bias was assessed using the Quality in Prognosis Studies tool. Pooled HRs were calculated using a random-effects model; heterogeneity was evaluated using the I2 statistic. Results Five studies (n = 3,186) were included. Higher MRR was significantly associated with lower risk for adverse events (HR per unit increase: 0.75; 95% CI: 0.64-0.88; I2 = 80.9%). When dichotomized, low MRR conferred a more than 2-fold increased risk for major adverse cardiovascular events (HR: 2.39; 95% CI: 1.66-3.43). Subgroup analysis showed a stronger prognostic effect for ST-segment elevation myocardial infarction (HR: 0.46) vs stable CAD (HR: 0.86; P for interaction < 0.0001). Threshold analysis identified MRR ≥ 3 as optimal for sensitivity (58.9%) and rule-out performance, while lower thresholds improved specificity. Conclusions MRR is a robust, independent predictor of cardiovascular outcomes of both acute and chronic CAD. Its prognostic impact is particularly pronounced for acute coronary syndrome. A threshold of 3 provides the best prognostic balance, supporting its integration into invasive physiological assessment for risk stratification.
