Showing papers in "Texas Heart Institute Journal in 2022"
TL;DR: An overview of the past, present, and future of artificial intelligence applications in cardiovascular medicine is provided and essential and powerful examples of machine-learning applications in industry and elsewhere are described.
Abstract: Artificial intelligence and machine learning are rapidly gaining popularity in every aspect of our daily lives, and cardiovascular medicine is no exception. Here, we provide physicians with an overview of the past, present, and future of artificial intelligence applications in cardiovascular medicine. We describe essential and powerful examples of machine-learning applications in industry and elsewhere. Finally, we discuss the latest technologic advances, as well as the benefits and limitations of artificial intelligence and machine learning in cardiovascular medicine.
4 citations
TL;DR: In this review, a brief overview of recent updates is provided and typical clinical situations related to the use of gadolinium-based contrast agents are discussed.
Abstract: Gadolinium-based contrast agents have expanded the diagnostic usefulness and capability of magnetic resonance imaging. Despite their highly favorable safety profile, these agents have been associated with nephrogenic systemic fibrosis in a small number of patients who have advanced kidney disease. Recently, trace amounts of gadolinium deposition in the brain and other organs have been reported after contrast exposure, even in patients with normal renal function. In this review, we provide a brief overview of recent updates and discuss typical clinical situations related to the use of gadolinium-based contrast agents.
4 citations
TL;DR: In this article , the authors provide physicians with an overview of the past, present, and future of artificial intelligence applications in cardiovascular medicine and discuss the benefits and limitations of Artificial Intelligence and Machine Learning in cardiovascular Medicine.
Abstract: Artificial intelligence and machine learning are rapidly gaining popularity in every aspect of our daily lives, and cardiovascular medicine is no exception. Here, we provide physicians with an overview of the past, present, and future of artificial intelligence applications in cardiovascular medicine. We describe essential and powerful examples of machine-learning applications in industry and elsewhere. Finally, we discuss the latest technologic advances, as well as the benefits and limitations of artificial intelligence and machine learning in cardiovascular medicine.
4 citations
TL;DR: In this article , a 42-year-old man presented with bilateral giant familial carotid body tumors associated with a concomitant skull-base paraganglioma, left-sided facial nerve palsy, and an incomplete circle of Willis.
Abstract: Carotid body tumors, rare neck paragangliomas arising from the common carotid artery bifurcation, can be classified as sporadic, hyperplastic, or familial. The familial type is often bilateral and associated with germline mutation of the mitochondrial enzyme succinate dehydrogenase. We report the rare case of a 42-year-old man who presented with bilateral giant familial carotid body tumors associated with a concomitant skull-base paraganglioma, left-sided facial nerve palsy, and an incomplete circle of Willis. We describe the excision of the tumors in 2 stages (the left mass and associated paraganglioma first and the right mass second), 6 months apart, with use of general anesthesia, and we discuss other operative considerations.
2 citations
TL;DR: This study shows that vWF deficiency, as seen in patients with vWD, is associated with a decreased prevalence of ischemic heart disease, and further investigation may confirm these findings.
Abstract: von Willebrand factor (vWF) aids coagulation at sites of vessel injury. Elevated vWF levels have been associated with an increased risk of ischemic heart disease (IHD); however, it is unclear whether vWF deficiency, seen in patients with von Willebrand disease (vWD), protects people against IHD. We determined and compared the prevalence and risk of IHD in patients with versus without vWD by using data from the National Inpatient Sample (2009-2014), excluding patients younger than 18 and older than 75 years. The primary outcome was the odds ratio (OR) of IHD in patients with versus without vWD. Secondary outcomes were major medical comorbidities and demographic characteristics in patients with vWD. Of 224,475,443 weighted hospital-discharge samples, we identified 82,809 patients with a vWD diagnosis. The odds of IHD were lower in patients with vWD than in those without (OR=0.54; 95% CI, 0.52-0.56). After multivariable logistic regression analysis and adjustment for age, sex, and typical IHD risk factors (hypertension, smoking, diabetes, hyperlipidemia, chronic kidney disease, obesity, and family history of IHD), the likelihood of IHD remained lower in patients with vWD than in patients without (OR=0.65; 95% CI, 0.63-0.67). Our study shows that vWF deficiency, as seen in patients with vWD, is associated with a decreased prevalence of IHD. Further investigation may confirm these findings.
2 citations
TL;DR: Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses.
Abstract: Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement full of expectations, hopes, and dreams fulfilled. Caged-ball prostheses underwent numerous modifications in design and materials to improve reliability and prevent specific mechanical and thrombogenic complications. Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses.
2 citations
TL;DR: The case of a man in his 50s who had undergone radical nephrectomy for renal cell carcinoma in 2006 and presented with amnesia at his neurology department in 2020, where radiation therapy and immunotherapy were initiated instead.
Abstract: Only 13 cases of renal cell carcinoma metastasis to the left atrium of the heart have been described. We report the case of a man in his 50s who had undergone radical nephrectomy for renal cell carcinoma in 2006 and presented with amnesia at our neurology department in 2020. Magnetic resonance images of the brain showed metastatic lesions; subsequent computed tomograms of the chest, abdomen, and pelvis revealed a mass in the left atrium and multiple metastases in the lung, pleura, and pancreas. Our cardiologists advised against surgical removal of the left atrial mass because of a poor prognosis, so radiation therapy and immunotherapy were initiated instead.
2 citations
TL;DR: The case of a man in his 50s who had undergone radical nephrectomy for renal cell carcinoma in 2006 and presented with amnesia at their neurology department in 2020 was described in this article .
Abstract: Only 13 cases of renal cell carcinoma metastasis to the left atrium of the heart have been described. We report the case of a man in his 50s who had undergone radical nephrectomy for renal cell carcinoma in 2006 and presented with amnesia at our neurology department in 2020. Magnetic resonance images of the brain showed metastatic lesions; subsequent computed tomograms of the chest, abdomen, and pelvis revealed a mass in the left atrium and multiple metastases in the lung, pleura, and pancreas. Our cardiologists advised against surgical removal of the left atrial mass because of a poor prognosis, so radiation therapy and immunotherapy were initiated instead.
2 citations
TL;DR: In this article , the authors reviewed the charts of patients who had an LVAD implanted at their institution from January 2009 through December 2019, to identify those with a device-related nontuberculous mycobacterial infection.
Abstract: Durable left ventricular assist devices (LVADs) provide circulatory support in patients with end-stage heart failure; however, complications include infection of the driveline exit site. Nontuberculous mycobacterial infections are rare in patients with LVADs, but they should be considered in those who have undergone device exchanges and have bacterial infections with driveline exit-site discharge but no fever or leukocytosis. We reviewed the charts of patients who had an LVAD implanted at our institution from January 2009 through December 2019, to identify those with a device-related nontuberculous mycobacterial infection. Collected data included patient demographics, premorbid conditions, infection type, previous device complications, treatment, and outcomes. We identified infections in 3 patients (mean age, 41 yr): Mycobacterium abscessus in 2 and M. chimaera in 1. All had a HeartMate II device and had undergone device exchanges for pump thrombosis or for driveline fault or infections. All presented with driveline exit-site discharge without fever or leukocytosis. The mean time between initial device implantation and diagnosis of a nontuberculous mycobacterial infection was 55 months. All 3 patients were treated with antibiotics and underwent localized surgical débridement; one underwent an additional device exchange. The M. abscessus infections disseminated, and both patients died; the patient with M. chimaera infection continued to take suppressive antibiotics. Nontuberculous mycobacterial infections are associated with high morbidity and mortality rates, warranting prompt diagnosis and treatment.
2 citations
TL;DR: The progress made in using the Apple Watch to record multiple electrocardiogram leads for diagnosing myocardial infarction is reviewed.
Abstract: Although the outcome after myocardial infarction depends on the time to treatment, a delay between symptom onset and treatment is common. Apple Watch, a popular wearable device, provides the ability to perform an electrocardiogram. We review the progress made in using the Apple Watch to record multiple electrocardiogram leads for diagnosing myocardial infarction. Although the data are encouraging, many limitations remain, and more research is needed. Nevertheless, the Apple Watch could eventually serve as a self-check tool for patients who have chest pains or other symptoms of myocardial infarction, thus substantially decreasing the time to treatment and improving the outcome after myocardial infarction.
2 citations
TL;DR: In this paper , the authors reviewed the progress made in using the Apple Watch to record multiple electrocardiogram leads for diagnosing myocardial infarction, which could eventually serve as a self-check tool for patients who have chest pains or other symptoms of myocardia.
Abstract: Although the outcome after myocardial infarction depends on the time to treatment, a delay between symptom onset and treatment is common. Apple Watch, a popular wearable device, provides the ability to perform an electrocardiogram. We review the progress made in using the Apple Watch to record multiple electrocardiogram leads for diagnosing myocardial infarction. Although the data are encouraging, many limitations remain, and more research is needed. Nevertheless, the Apple Watch could eventually serve as a self-check tool for patients who have chest pains or other symptoms of myocardial infarction, thus substantially decreasing the time to treatment and improving the outcome after myocardial infarction.
TL;DR: With LVAD support, longitudinal sleeve gastrectomy, and dietary protocols, most of patients with morbid obesity and advanced heart failure lost enough weight for transplant eligibility and support from physicians and dietitians can maximize positive results in these patients.
Abstract: Combining left ventricular assist device (LVAD) implantation and longitudinal sleeve gastrectomy may enable patients with morbid obesity to lose enough weight for heart transplant eligibility. In a retrospective study, we evaluated long-term outcomes of patients with body mass indexes ≥35 who underwent LVAD implantation and longitudinal sleeve gastrectomy during the same hospitalization (from January 2013 through July 2018) and then adhered to a dietary protocol. We included 22 patients (mean age, 49.9 ± 12.5 yr; mean preoperative body mass index, 43.3 ± 6.2). Eighteen months after gastrectomy, all 22 patients were alive, and 16 (73%) achieved a body mass index of less than 35. Myocardial recovery in 2 patients enabled LVAD removal. As of October 2020, 10 patients (45.5%) had undergone heart transplantation, 5 (22.3%) were waitlisted, 5 (22.3%) still had a body mass index ≥35, and 2 (9%) had died. With LVAD support, longitudinal sleeve gastrectomy, and dietary protocols, most of our patients with morbid obesity and advanced heart failure lost enough weight for transplant eligibility. Support from physicians and dietitians can maximize positive results in these patients.
TL;DR: The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement as discussed by the authors .
Abstract: Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement full of expectations, hopes, and dreams fulfilled. Caged-ball prostheses underwent numerous modifications in design and materials to improve reliability and prevent specific mechanical and thrombogenic complications. Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses.
TL;DR: In this article , the authors describe how individuals are targeted, suggest educational resources, and offer physicians ideas regarding effective counseling, which can help patients to understand the risks of unproven stem cell interventions and where to refer patients.
Abstract: The intense marketing of unproven stem cell interventions (SCIs) has become an international health concern, and relying on government regulators to shut down unscrupulous clinics is no longer an option.1 Physicians are typically excellent resources when patients have questions about various medical therapies. Because many SCIs have not been approved for use, specialists are unlikely to raise the topic with patients, and other physicians may not be fully prepared to discuss them. Our goal is to describe how individuals are targeted, suggest educational resources, and offer physicians ideas regarding effective counseling.Stem cell interventions have been marketed internationally for many years,2 and more than 2,700 SCI clinics currently operate in the United States.3,4 Unproven SCIs are promoted as therapy for a specific medical condition or as a panacea for a broad range of conditions. Direct advertising targets patients who have serious illnesses or painful injuries that are refractory to conventional treatments.3,5 Advertisements for treatments misinform patients by emphasizing the general promise of regenerative medicine and strongly imply that they are scientifically legitimate. Potential clients are targeted on websites, in seminars, and through social media, typically with testimonials from patients (actual or purported) and celebrities. The benefits of unproven SCIs are exaggerated, risks are downplayed, and the requirement for United States Food and Drug Administration approval is minimized or ignored.Some SCI clinics offer autologous stem cells derived from fat or bone marrow, and others use allogeneic sources, including birth tissue.6,7 Whereas practitioners may be chiropractors or naturopathic healers, most seem to be physicians who are practicing outside their scope of training.8,9 Health risks for patients in such circumstances are inherent. Sepsis, blindness, infections, and tumor formation were among the 360 adverse events (some fatal) reported after the use of unproven SCIs.10 Beyond the medical risks, out-of-pocket treatment costs can range from $2,500 to more than $50,000 per session, causing some patients to solicit crowdfunding donations.11,12Physicians have a crucial role in helping to inform and guide patients who are enticed to try unproven SCIs. Specialists have cited concerns about the scientific uncertainties of unproven SCIs, misleading marketing, and physical harms, as well as the monetary costs.13 Informational and relational approaches are both used when counseling patients.14 Many specialists are comfortable discussing unproven SCIs; however, about one-third, including junior practitioners, feel underprepared to give advice.14,15 Learning about the risks of unproven SCIs and where to refer patients are important, but even more benefit can be gained by improving communication skills and expressing appropriate empathy.Misinformation can cause patients to confuse the for-profit therapy offered by SCI clinics with legitimate clinical trials sponsored by hospitals and academic medical centers. Physicians are ethically and professionally bound to inform patients about evidence-based therapies,16 and they may refer patients to ClinicalTrials.gov for appropriate trials; however, several for-profit clinics have registered their SCIs, clouding the search for genuine clinical trials.6,17 To aid patients, the International Society for Stem Cell Research (ISSCR) has created educational materials to dispel myths and reinforce facts. Two prevalent myths are that all autologous stem cells are safe, and that one type of stem cell can effectively treat multiple unrelated conditions. The ISSCR warns that testimonials for unproven SCIs can be misleading, and that genuine clinical trials typically do not require participants to pay.18Physicians can help patients understand the validity of information from websites, blogs, social media platforms, and news articles.19 Patients can also benefit from being referred to regenerative medicine consultation services,5,20 to media-review organizations that scrutinize news stories and press releases,21 and to scientific societies such as the ISSCR, all of which provide warnings about unproven SCIs.18,22,23Patients may be reluctant to talk about unproven SCIs with their doctors. When a physician dismisses their interest, patients may be more inclined to visit unproven-SCI clinics where practitioners make them feel heard and entice them with false hopes.14,24 Accordingly, physicians should practice being nonjudgmental19; they should invite questions and carefully listen to clarify what patients know about SCIs and why they are interested. They should also avoid overstating their own concerns about the legitimacy of SCIs.25 By providing clear, evidence-based, jargon-free recommendations, communicating compassionately, and affirming their continued care and concern, physicians can effectively educate patients about unproven SCIs.The authors thank the George and Mary Josephine Hamman Foundation for sponsoring the 2021 Baker Institute–Texas Heart Institute lecture series26 and thank Daisy Jasso for transcribing the lecture notes.Funding/support: Funding for this project was provided by a grant from the George and Mary Josephine Hamman Foundation. Dr. Master and Mr. Kawam are supported by a grant from the National Institute on Aging, National Institutes of Health (R21AG068620). Dr. Master is supported by the Center for Regenerative Medicine at Mayo Clinic.Disclosures: Drs. Matthews and Master are Lawrence Goldstein Science Policy Fellows for the International Society for Stem Cell Research (ISSCR) and ex officio members of the ISSCR's Public Policy Committee. Dr. Master serves on the ISSCR's Education Committee. Neither individual was paid by the ISSCR nor involved in developing ISSCR patient-education materials.Contributions: Drs. Matthews and Master contributed equally to this report.
TL;DR: A 60-year-old man was about to undergo minimally invasive aortic valve replacement when transesophageal echocardiography revealed an intracardiac mass on the left atrial free wall as discussed by the authors .
Abstract: A 60-year-old man was about to undergo minimally invasive aortic valve replacement when transesophageal echocardiography revealed an intracardiac mass on the left atrial free wall. Multimodal images from 5 months earlier had shown no mass. We converted the procedure to open surgery. The excised mass resembled a cardiac myxoma but was determined to be a papillary fibroelastoma. This case illustrates that papillary fibroelastomas can form and grow rapidly, warranting alertness for their unexpected discovery before and during cardiac surgical procedures.
TL;DR: In this article , the authors report a case of a 37-year-old man who recovered from mild COVID-19 only to present a few weeks later with devastating cardiovascular involvement that included severe left ventricular impairment resulting from nonischemic cardiomyopathy, multiple left-vascular thrombi, and embolic stroke.
Abstract: COVID-19 is a novel disease with multisystem involvement, but most patients have pulmonary and cardiovascular involvement in the acute stages. The cardiovascular impact of acute COVID-19 is well recognized and ranges from myocarditis, arrhythmias, and thrombotic occlusion of coronary arteries to spontaneous coronary artery dissection and microthrombi in small coronary vessels on autopsy. We report a case of a 37-year-old man who recovered from mild COVID-19 only to present a few weeks later with devastating cardiovascular involvement that included severe left ventricular impairment resulting from nonischemic cardiomyopathy, multiple left ventricular thrombi, and embolic stroke.
TL;DR: The rare case of a 42-year-old man who presented with bilateral giant familial carotid body tumors associated with a concomitant skull-base paraganglioma, left-sided facial nerve palsy, and an incomplete circle of Willis is reported.
Abstract: Carotid body tumors, rare neck paragangliomas arising from the common carotid artery bifurcation, can be classified as sporadic, hyperplastic, or familial. The familial type is often bilateral and associated with germline mutation of the mitochondrial enzyme succinate dehydrogenase. We report the rare case of a 42-year-old man who presented with bilateral giant familial carotid body tumors associated with a concomitant skull-base paraganglioma, left-sided facial nerve palsy, and an incomplete circle of Willis. We describe the excision of the tumors in 2 stages (the left mass and associated paraganglioma first and the right mass second), 6 months apart, with use of general anesthesia, and we discuss other operative considerations.
TL;DR: It is suggested that male sex, absence of typical VPC-related symptoms, and a VPC QRS duration >157 ms are associated with LV dysfunction in patients with frequent VPCs, findings that may be useful in predicting such dysfunction.
Abstract: Frequent ventricular premature complexes (VPCs) and VPC QRS duration are risk factors for left ventricular (LV) dysfunction. To determine which clinical characteristics and electrocardiographic features are associated with LV dysfunction (ejection fraction, <50%) and frequent VPCs, we retrospectively reviewed data from a single-center registry of all patients diagnosed with frequent VPCs at a Korean outpatient clinic. We identified 412 consecutive outpatients (mean age, 54.7 ± 16.8 yr; 227 women [55.1%]) who were diagnosed with frequent VPCs and had no structural heart disease from January 2010 through December 2017. Available transthoracic echocardiograms and 24-hour Holter monitoring data were evaluated to correlate the occurrence of VPCs and symptoms. Typical VPC-related symptoms (palpitations or dropped beats) were observed in 251 patients (61.1%). Electrocardiograms revealed VPCs with a left bundle branch block-like morphology in 327 patients (79.5%) and VPCs with an inferior axis in 353 (85.8%). Twenty-six patients (6.3%) were diagnosed with VPC-related LV dysfunction. The mean VPC burden did not differ significantly by LV functional status (11.06% ± 10.13% [normal] vs 14.41% ± 13.30% [impaired]; P=0.211). Patients with impaired LV function were more often men (P=0.027), had no typical VPC-related symptoms (P=0.006), and had significantly longer VPC QRS durations (mean, 157 ms vs 139 ms; P <0.01). Our findings suggest that male sex, absence of typical VPC-related symptoms, and a VPC QRS duration >157 ms are associated with LV dysfunction in patients with frequent VPCs, findings that may be useful in predicting such dysfunction.
TL;DR: In this article , a 66-year-old man had an enlarging aortic aneurysm sac after an endovascular repair procedure that had been performed at another institution 4 years previously; it was without any endoleak but was complicated by the occlusion of the left limb, requiring cross-femoral bypass.
Abstract: A 66-year-old man had an enlarging aortic aneurysm sac after an endovascular aortic replacement procedure that had been performed at another institution 4 years previously; it was without any endoleak but was complicated by the occlusion of the left limb, requiring cross-femoral bypass. Current computed tomography revealed dilatation of the proximal neck and the right common iliac artery. A type Ib endoleak was found from the distal end of the right limb of the endograft, possibly secondary to the dilatation of the artery around it; it then pressurized and caused the dilatation of the juxtarenal aorta around the proximal landing zone and induced a concomitant type Ia endoleak. The patient was operated on owing to the risk of rupture. Pelvic ischemia was a concern during decision-making. The patient underwent removal of the endograft and replacement of a bifurcated aortoiliac and femoral graft with good outcome. Midline laparotomy and a supraceliac clamping approach enable the removal of endografts with suprarenal fixation and revascularization of internal iliac arteries. Open repair offers a definitive solution for complicated endoleaks when endovascular options could be risky and ineffective.
TL;DR: It is shown that patients with AFD can safely undergo exercise testing but have a high incidence of exercise-induced arrhythmias and ischemic changes.
Abstract: Patients with Anderson-Fabry disease (AFD) have an elevated incidence of resting arrhythmias and ischemic heart disease, but their exercise arrhythmia burden and ischemic changes are not well understood. In addition, little research has been done on heart rate recovery in these patients. We retrospectively reviewed charts of patients with AFD who underwent maximal effort cardiopulmonary exercise testing (CPET) (n=44; 38.2 ± 13.8 yr; 23 men) from 2012 through 2018. Electrocardiographic, Holter monitoring, echocardiographic, cardiac magnetic resonance imaging, and patient demographic data were collected. No patient had adverse events that necessitated CPET termination, whereas 25 (57%) had ectopy during CPET, including 3 (7%) with frequent premature atrial contractions and 5 (11%) with frequent premature ventricular contractions. The ectopic burden was higher during resting electrocardiographic monitoring before exercise. In addition, 7 patients (16%) had pathologic ST-segment or T-wave changes on CPET, defined as ST-segment changes ≥2 mm. Among the patients who had concurrent cardiac magnetic resonance findings with their CPET (n=27), ST-segment or T-wave changes were associated with left ventricular myocardial mass (r=0.43, P=0.02). Chronotropic incompetence was seen during CPET in 28 patients (64%); however, only 2 patients (4%) had abnormal heart rate recovery at 1 minute. This study shows that patients with AFD can safely undergo exercise testing but have a high incidence of exercise-induced arrhythmias and ischemic changes. Ischemic electrocardiographic changes during exercise testing are associated with myocardial mass. Despite the chronotropic incompetence associated with AFD, heart rate recovery appears to be generally preserved in these patients.
TL;DR: It is important to research devices studied up to this point to find the best smart device to detect the aforementioned arrhythmias, with most of the devices being photoplethysmography based for detection of atrial fibrillation.
Abstract: Atrial fibrillation is the most commonly experienced type of cardiac arrhythmia and is the most associated with substantial clinical occurrences and expenses. This arrhythmia often occurs in its "silent" asymptomatic form, revealed only after complications such as a stroke or congestive heart failure have transpired. New smart devices confer effective advantages in the detection of this heart arrhythmia, of which photoplethysmography-based smart devices have shown great potential, according to previous research. However, the solution becomes a problem as widespread use and high availability of various applications and smart devices may lead to substantial amounts of false and misleading recordings and information, causing unnecessary anxiety regarding arrhythmic occurrences diagnosed by the devices but not professionally confirmed. Thus, with most of the devices being photoplethysmography based for detection of atrial fibrillation, it is important to research devices studied up to this point to find the best smart device to detect the aforementioned arrhythmias.
TL;DR: In this paper , the authors investigated the relationship between coronary collateral circulation (CCC) and intracoronary thrombus burden in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI).
Abstract: This study investigated the relationship between coronary collateral circulation (CCC) and intracoronary thrombus burden in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). CCC and thrombus burden are predictive of clinical outcomes in patients with STEMI.Patients with STEMI undergoing primary percutaneous coronary intervention were enrolled (n = 172). CCC was graded according to the Cohen-Rentrop classification. Patients were classified as insufficient (grade 0 or 1, n = 134) or well-developed (grade 2 or 3; n = 38) CCC. The Thrombolysis in Myocardial Infarction scale was used to evaluate intra-coronary thrombus burden. The low-thrombus-burden group comprised those with grades 0 to 2, and the high-thrombus-burden group comprised those with grades 3 or 4.Right coronary artery infarcts had a 13.830-fold higher chance of having well-developed CCC than did left anterior descending artery infarcts (P < .001). Circumflex artery infarcts had a 7.904-fold higher chance of well-developed CCC than did left anterior descending artery infarcts (P = .016). High thrombus burden was associated with a 4.393-fold higher chance for well-developed CCC than was low thrombus burden (P = .030). Low albumin levels were related to a greater chance of having well-developed CCC (P = .046).Patients with well-developed CCC have higher thrombus burden than do those with insufficient CCC. Because well-developed CCC is an indicator of more severe underlying lesions, we speculate that patients with severe lesions are more prone to experience more complicated STEMI with high thrombus burden.
TL;DR: Implantable loop recorders enable continuous, long-term detection of important subclinical arrhythmias in selected patients who have LVNC and moderate or greater ventricular dysfunction and may prove to be most valuable in patients with LVNC.
Abstract: Patients with left ventricular noncompaction (LVNC) are at risk of clinically significant arrhythmias and sudden death. We evaluated whether implantable loop recorders could detect significant arrhythmias that might be missed in these patients during annual Holter monitoring. Selected pediatric and adult patients with LVNC who consented to implantable loop recorder placement were monitored for 3 years (study duration, 10 April 2014-9 December 2019). Fourteen subjects were included (age range, 6.5-36.4 yr; 8 males). Of 13 patients who remained after one device extrusion, one underwent implantable cardioverter-defibrillator placement. Four patients (31%) had significant arrhythmias: atrial tachycardia (n=2), nonsustained ventricular tachycardia (n=1), and atrial fibrillation (n=1). All 4 events were clinically asymptomatic and not associated with left ventricular ejection fraction. In addition, a high frequency of benign arrhythmic patterns was detected. Implantable loop recorders enable continuous, long-term detection of important subclinical arrhythmias in selected patients who have LVNC. These devices may prove to be most valuable in patients who have LVNC and moderate or greater ventricular dysfunction.
TL;DR: It is indicated that an untreated RAA with an aberrant left subclavian artery may be associated with an increased risk of developing subclAVian artery steal syndrome.
Abstract: Vascular ring is a rare congenital anomaly in which the abnormal origin of the aorta or its branches and pulmonary arteries leads to encircling and compression of the trachea and esophagus. A right aortic arch (RAA) with an aberrant left subclavian artery is one of the most common forms of vascular ring. Here, we report a case of a prenatally diagnosed vascular ring resulting from an RAA with an aberrant left subclavian artery. When the infant was 7 months of age, the development of noisy breathing prompted further evaluation with cardiac magnetic resonance imaging that showed an atretic left subclavian artery associated with collateral retrograde flow from the left vertebral artery to the distal portion of the subclavian artery. Our findings indicate that an untreated RAA with an aberrant left subclavian artery may be associated with an increased risk of developing subclavian artery steal syndrome.
TL;DR: In this paper , the authors used photoplethysmography-based smart devices to detect atrial fibrillation in the silent asymptomatic form, revealed only after complications such as a stroke or congestive heart failure have transpired.
Abstract: Atrial fibrillation is the most commonly experienced type of cardiac arrhythmia and is the most associated with substantial clinical occurrences and expenses. This arrhythmia often occurs in its "silent" asymptomatic form, revealed only after complications such as a stroke or congestive heart failure have transpired. New smart devices confer effective advantages in the detection of this heart arrhythmia, of which photoplethysmography-based smart devices have shown great potential, according to previous research. However, the solution becomes a problem as widespread use and high availability of various applications and smart devices may lead to substantial amounts of false and misleading recordings and information, causing unnecessary anxiety regarding arrhythmic occurrences diagnosed by the devices but not professionally confirmed. Thus, with most of the devices being photoplethysmography based for detection of atrial fibrillation, it is important to research devices studied up to this point to find the best smart device to detect the aforementioned arrhythmias.
TL;DR: Current applications of machine learning and their use in cardiac electrophysiology are presented and machine learning supplemented with novel visualization technologies could substantially improve patient care and outcomes by helping physicians to make more informed patient-specific decisions.
Abstract: Cardiac electrophysiology requires the processing of several patient-specific data points in real time to provide an accurate diagnosis and determine an optimal therapy. Expanding beyond the traditional tools that have been used to extract information from patient-specific data, machine learning offers a new set of advanced tools capable of revealing previously unknown data patterns and features. This new tool set can substantially improve the speed and level of confidence with which electrophysiologists can determine patient-specific diagnoses and therapies. The ability to process substantial amounts of data in real time also paves the way to novel techniques for data collection and visualization. Extended realities such as virtual and augmented reality can now enable the real-time visualization of 3-dimensional images in space. This enables improved preprocedural planning and intraprocedural interventions. Machine learning supplemented with novel visualization technologies could substantially improve patient care and outcomes by helping physicians to make more informed patient-specific decisions. This article presents current applications of machine learning and their use in cardiac electrophysiology.
TL;DR: A 24-year-old woman with a history of mitral valve prolapse who presented with fatigue and palpitations was found to have a right atrial mass compatible with a myxoma as discussed by the authors .
Abstract: Cardiac thrombus, the most common intracardiac mass, is typically seen in the left side of the heart in the presence of atrial fibrillation, mitral stenosis, or impaired global wall motion. Right atrial thrombus, which is rarer, is usually associated with central venous catheter placement or pulmonary embolism. We present the case of a 24-year-old woman with a history of mitral valve prolapse who presented with fatigue and palpitations. Echocardiograms and cardiac magnetic resonance images revealed a right atrial mass compatible with a myxoma. However, after surgical excision of this and a second mass discovered intraoperatively, pathologic evaluation confirmed organized thrombus rather than myxoma. The patient's only risk factor was her use of oral contraceptive pills. Test results for hypercoagulable disorders revealed the presence of antiphosphatidylserine, an uncommon antiphospholipid antibody. The patient stopped taking the contraceptive. This case suggests the need to examine further the role of antiphosphatidylserine antibodies in the diagnosis of antiphospholipid syndrome.
TL;DR: An extreme case of supracardiac total anomalous pulmonary venous return in an infant who survived 7 months despite atypical anomalous inflow without atrial-level communication and with right-to-left shunting only through a patent ductus arteriosus is reported.
Abstract: Total anomalous pulmonary venous return is a congenital heart malformation characterized by anomalous pulmonary venous inflow to the right atrium. Surgical repair typically occurs during the first month of life, and survival beyond that age in untreated patients is unlikely. We report an extreme case of supracardiac total anomalous pulmonary venous return in an infant who survived 7 months despite atypical anomalous inflow without atrial-level communication and with right-to-left shunting only through a patent ductus arteriosus. We stabilized the patient's left-sided heart function before surgically repairing the anomalous venous return 2 months later. Three years postoperatively, the patient was well.
TL;DR: In this paper , the authors evaluated the use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation.
Abstract: BACKGROUND
The failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice.
METHODS
This research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared.
RESULTS
No significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P = .36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P = .14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P = .25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P = .34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P = .044).
CONCLUSION
Finding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal "bailout" procedure.