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This document, developed by the AI-SPRINT project, describes the first release and evaluation of the monitoring subsystem. The final release and evaluation of the monitoring subsystem is due at M24. The document describes the components involved in monitoring subsystems, as well as the results of the preliminary evaluation. The technological choices are taken considering the requirements elicited in AI-SPRINT Deliverable D1.2 Requirements Analysis. The document first introduces the functional and non-functional requirements of the monitoring subsystem. Next the focus is on an analysis and evaluation of the available open source tools. Finally, the document describes the innovative architecture that will be developed within the AI-SPRINT project which allows monitoring data collection also in case of edge/cloud disconnection and logs collection. The Proof of Concepts (PoCs) developed so far, the tests conducted and a roadmap for the development activities are also described. It is worth mentioning that the architecture proposed in this document passed preliminary evaluation. The PoCs we implemented cover the most crucial parts of the implementation and tests in laboratory environments have been conducted. The results indicate that the monitoring subsystem will pass the requirements towards scalability and performance with no issues. The most important goals for the next twelve months are the implementation of means to easily define custom metrics, the support for hierarchical deployment and the automation of monitoring subsystem deployments and configuration., {"references":["Project deliverable","Open Access"]}

Aims Hypertension (HTN) is a well-known contributor to cardiovascular disease, including heart failure (HF) and coronary artery disease, and is the leading risk factor for premature death world-wide. A J- or U-shaped relationship has been suggested between blood pressure (BP) and clinical outcomes in different studies. However, there is little information about the significance of BP on the outcomes of patients with coronary artery disease and left ventricular dysfunction. This study aimed to determine the relationship between BP and mortality outcomes in patients with ischaemic cardiomyopathy. Methods and results The influence of BP during a median follow-up of 9.8 years was studied in a total of 1212 patients with ejection fraction ≤35% and coronary disease amenable to coronary artery bypass grafting (CABG) who were randomized to CABG or medical therapy alone (MED) in the STICH (Surgical Treatment for Ischaemic Heart Failure) trial. Landmark analyses were performed starting at 1, 2, 3, 4, and 5 years after randomization, in which previous systolic BP values were averaged and related to subsequent mortality through the end of follow-up with a median of 9.8 years. Neither a previous history of HTN nor baseline BP had any significant influence on long-term mortality outcomes, nor did they have a significant interaction with MED or CABG treatment. The landmark analyses showed a progressive U-shaped relationship that became strongest at 5 years (χ2 and P-values: 7.08, P = 0.069; 8.72, P = 0.033; 9.86; P = 0.020; 8.31, P = 0.040; 14.52, P = 0.002; at 1, 2, 3, 4, and 5-year landmark analyses, respectively). The relationship between diastolic BP (DBP) and outcomes was similar. The most favourable outcomes were observed in the SBP range 120-130, and DBP 75-85 mmHg, whereas lower and higher BP were associated with worse outcomes. There were no differences in BP-lowering medications between groups. Conclusion A strong U-shaped relationship between BP and mortality outcomes was evident in ischaemic HF patients. The results imply that the optimal SBP might be in the range 120-130 mmHg after intervention, and possibly be subject to pharmacologic action regarding high BP. Further, low BP was a marker of poor outcomes that might require other interactions and treatment strategies. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.

Early reperfusion therapy with primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) improves left ventricular function and reduces mortality.To assess the time delay in treatment of patients with STEMI referred to a twenty-four-hour interventional centre located in the vicinity of the centre of Warsaw.We analysed 350 consecutive STEMI patients admitted to our Department between October 2005 and September 2006. The majority of the patients - 244 (69.7%), were admitted via hospitals without an interventional department. Sixty-two (17.7%) patients were transported directly by ambulance from home, 34 (9.7%) from a community health centre and 10 patients (2.9%) came by themselves from home or work. A detailed interview concerning the time of symptom onset was conducted in 342 patients (97.7%).Sixty-two (18%) patients arrived at the interventional centre within the first 2 hours from symptom onset: 6 women (5.5% of all women in the study population) and 56 (24.1%) men (p0.0001). Within the first 2 hours, 32 (13.1%) patients were admitted via another hospital and 20 (32.2%) directly by ambulance (p0.001). During the first 7 days of hospitalisation the following patients died: 2 (3.2%) patients admitted within the first 2 hours via another hospital, 6 (3.4%) patients among 178 admitted between 2 and 6 hours after pain onset, 4 (8.3%) among 48 admitted between 6 and 12 hours and 8 (14.8%) among 54 patients with the pain duration over 12 hours (p0.02). During the first 7 days of hospitalisation 8 (3.3%) patients admitted within the first 6 hours after pain onset died compared with 12 (11.8%) admitted later (p0.003).In the interventional centre located near the centre of Warsaw symptom-onset-to-door time was 120 minutes only in 18% of patients with STEMI. Almost 70% of patients underwent interhospital transfer for primary PCI. Prolongation of the time from onset of symptoms to successful PCI worsened prognosis. When transporting patients with acute coronary syndrome, efforts should be made to avoid district hospitals without a catheterisation laboratory. Direct transportation by ambulance or helicopter with educated staff equipped with ECG teletransmission data, which may substantially shorten time to treatment, should be preferred.

Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients agedor =80 years.To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patientsor =80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age.In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83+/-3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied.Severity of coronary atherosclerosis measured by angiographic Gensini score and author's own score was similar in diabetic and non-diabetic patients (23.25+/-9.6 vs. 20.6+/-10.2; NS, and 9.1+/-6.0 vs. 8.1+/-5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosis20%, was obtained in 92.2% of patients with DM compared to 83.7% of non-diabetics (NS). One-day mortality was 7.1 vs. 6.1% (NS), in-hospital mortality was 7.1 vs. 17.4% (NS). Successful pPCI reduced 30-day mortality threefold (OR=0.31; p0.05). Contrast-induced nephropathy occurred in 35.7% of diabetic patients compared to 26.5% of those without diabetes (NS) Contrast-induced nephropathy increased risk for in-hospital mortality fivefold (p0.02). No significant correlation between DM or baseline glucose level and in-hospital mortality was found. During one-year follow-up mortality rate in diabetic patients was 38.5% compared to 7.3% of those without diabetes (p0.01). One-year mortality predictors were: age (OR=1.27; p=0.0047), metabolic syndrome (OR=4.4; p0.04), type 2 diabetes (OR=5.25; p0.02), insulin treatment (OR=5.7; p0.03), baseline glucose level (OR=1.01; p0.007), maximum CK-mass level (OR=1.006; p0.05), noninvasive STEMI management (OR=5.0; p0.02), and stroke (OR=7.5; p0.006). Stroke (OR=40.0; p0.005) and diabetes (OR=6.2; p0.01) were identified by multivariable analysis as independent risk factors of one-year mortality.In patients with DM agedor =80 years with ACS-STE, severity of coronary atherosclerosis and in-hospital prognosis after pPCI seems to be similar to subjects in the same age without DM. Diabetes mellitus is an independent risk factor of one-year mortality after successful pPCI.

The effect of infarct size estimated from serial CK-MB isoenzyme determinations on the incidence of atrioventricular and intraventricular conduction disturbances was examined in 250 patients suffering their first myocardial infarction. The size of the infarct was significantly greater (P less than 0.001) in 72 patients with conduction disturbances than in 178 without conduction defects (54 +/- 29 vs. 35 +/- 22 CK-MB gEq). The largest size was observed in 10 patients with bifascicular block (71 +/- 38 CK-MB gEq). Within the group of patients with intraventricular conduction disturbances, the size of the infarct was significantly greater (P less than 0.01) when localized inferiorly rather than anteriorly (91 +/- 10 vs. 58 +/- 27 CK-MB gEq). The size in those patients with complete atrioventricular block and anterior infarction was larger than in those with an inferior lesion (76 +/- 21 vs. 52 +/- 33 CK-MB gEq). The size in those patients with inferior infarction and complete block was significantly greater (P less than 0.05) than in patients with similarly positioned infarction without conduction disturbances (52 +/- 33 vs. 35 +/- 22 CK-MB gEq). There was no significant difference in the size of infarct when inferior infarction was complicated by first- and second-degree block in comparison to those without conduction defects (38 +/- 23 vs. 35 +/- 22 CK-MB gEq). A correlation was observed between the size of infarction and the incidence of conduction disturbances (P less than 0.001); the greater the size the higher the incidence of conduction disturbances.

The effects of intravenous nitroglycerin (TNG) were evaluated in 39 patients with a first acute mycocardial infarction, subdivided according to Killip into those with left ventricular failure (N = 24) and those without (N = 15). A group of 38 randomly selected patients treated in a conventional, but unstandardized manner, served as a control (C). TNG caused a statistically significant reduction in pulmonary artery diastolic pressure, regardless of its initial value, by about 30%. Neither cardiac index nor total peripheral resistance was significantly changed. Infarct size, measured in gEq of isoenzyme MB creatine kinase (CK-MB), was smaller by about 40% in both subgroups of patients treated with TNG, when compared with the controls. A significant difference was found in peak CK-MB blood levels only in the group of patients with left ventricular failure (Killip classes II and III) treated with TNG. The best results were obtained when TNG was given not later than 4 h after the onset of the symptoms of infarction.

The effects of intravenous nitroglycerin (NTG), trimetaphan (TMP), and phentolamine (PTL) on pulmonary artery diastolic pressure (PADP), systemic arterial pressure (SAP), cardiac index (CI) and systemic vascular resistance (SVR) in patients (12 in each treated group) with chronic ischaemic heart failure are analyzed. Each group was divided into two subgroups according to the initial PADP taking into account the mean value in the whole group. A significant decrease in PADP (by 40%; p less than 0.001) was observed in the NTG-treated group, with no significant changes in CI and SVR except for patients with moderately elevated initial PADP, in whom SVR increased slightly in the early period of treatment, and CI decreased (by 25%; p less than 0.05). TMP and PTL reduced SVR (by 25 and 30% respectively; p less than 0.01) and increased CI irrespective of the initial PADP. TMP significantly decreased PADP in patients in whom its level was initially high. The results suggest that NTG is mainly a venodilating agent which should be used in patients with high PADP and normal or slightly decreased CI. PTL acts mainly by reducing SVR and increasing CI. TMP influences both PADP and SVR and is a drug of choice in patients with high or elevated PADP and low cardiac output.

On the basis of their own 5-year experience, the authors discuss the indications for, and limitations of, intravenous infusion of nitroglycerin (NTG). In 42 patients with postinfarction heart failure, NTG produced a significant reduction of left ventricular filling pressure, regardless of its initial value. In patients with normal or only slightly elevated left ventricular filling pressure, NTG caused a decrease in cardiac index and mean arterial pressure as well as, in the earliest phase of infusion, an increase in peripheral resistance. Similar trends were observed also in patients with markedly elevated left ventricular filling pressure if mean arterial blood pressure fell by more than 20%. Taking into consideration that the range of the effective doses was very wide (15-150 micrograms/min), the authors believe that intravenous NTG infusion is indicated mainly in cases of manifest heart failure and should be administered under strict control of the dosage and with careful monitoring of the therapeutic effects.

In 70 consecutive patients (pts) with acute transmural inferior infarction, 58 had significant precordial ST depression (group A) and the remaining 12 had no ECG changes in precordial leads (group B) on admission. At the time of hospital discharge, the persistence of anterior ST depression was observed in 13 pts (group A1), normalization in 45 (group A2). Infarct size was significantly greater (p less than 0.05) in group A than in group B (37.6 vs. 23.8 CK-MB gEq). The largest infarct (51.5 CK-MB gEq) and the most serious clinical course was observed in group A1. No significant differences were noticed in the frequency of reinfarction and episodes of acute coronary insufficiency during hospitalization and one-year follow-up between groups. Persistent precordial ST depression is a simple ECG marker of extensive infarction, left ventricular dysfunction and a worse clinical course.