Expertise In Cardiology Research Articles

Hematological Complications From Transcatheter Aortic Valve Replacement (TAVR): Recognition and Treatment.

Transcatheter aortic valve replacement (TAVR) has emerged as a pivotal intervention for patients with severe aortic stenosis who are at high or prohibitive surgical risk. Although TAVR is a minimally invasive procedure, it is linked to serious hematological problems, most notably thrombosis and bleeding. Numerous factors, such as procedural features, patient comorbidities, and anticoagulation management techniques, contribute to these complications. Bleeding complications can be major, minor, or life-threatening. They can be caused by problems with the vascular access site, anticoagulation medication, or coexisting conditions like renal dysfunction and frailty. Hemoglobin drop, overt bleeding, and hematoma signs must all be closely watched to identify bleeding. Careful selection and modification of anticoagulation medication, the use of vascular closure devices, and timely attention to bleeding sites are examples of management techniques. Thrombotic consequences, which include cerebrovascular accidents and valve thrombosis, are caused by endothelial injury, stent implantation, and patient hypercoagulability. Imaging modalities such as computed tomography and transesophageal echocardiography are used in the crucial process of detection. The goal of preventive care is to maximize anticoagulation regimens that are customized to each patient's risk profile, frequently striking a balance between the risk of thrombosis and bleeding. A multidisciplinary strategy that integrates surgical, hematological, and cardiology expertise is necessary for the effective management of these hematological complications. To improve patient outcomes, ongoing research attempts to improve risk stratification and create safer anticoagulation protocols. This review emphasizes how critical it is to identify bleeding and thrombotic events as soon as possible and treat them promptly to reduce the risk of negative outcomes for TAVR patients.

Defining the Cross-Volume Effect of Extracorporeal Life Support on Outcomes of Cardiogenic Shock

BackgroundCardiogenic shock (CS) remains a leading cause of mortality despite advancements in mechanical circulatory support and other management strategies. In particular, venoarterial extracorporeal membrane oxygenation (ECMO) requires expertise in cardiac surgery, cardiology, and critical care. The benefits of such expertise may extend beyond patients undergoing ECMO. MethodsHospitalizations in adults (aged ≥18 years) with a primary diagnosis of CS who were not undergoing ECMO, cardiac operations, durable left ventricular assist device therapy, or heart transplantation were abstracted from the 2016-2020 Nationwide Readmissions Database. Multivariable regression models were developed to assess the association of cardiac surgical and ECMO institutional caseload with clinical and financial outcomes. ResultsOf an estimated 70,339 patients with CS identified for study, 33,643 (47.8%) were treated at a high-volume hospital for ECMO (HVH-ECMO). HVH-ECMO was associated with decreased odds of in-hospital mortality (adjusted odds ratio [aOR], 0.85; 95% CI, 0.75-0.95), respiratory complications (aOR, 0.86; 95% CI, 0.79-0.94), and nonhome discharge (aOR, 0.86; 95% CI, 0.79-0.94). However, HVH-ECMO was associated with a longer length of stay by 1.7 days (95% CI, 1.3-2.1) and higher inpatient costs by $9170 (95% CI, $6,490-$12,060). Although ECMO volume was inversely associated with the predicted risk of in-hospital mortality, institutional volume of cardiac operations was not significantly associated with mortality. ConclusionsOur findings suggest improved outcomes for patients with CS who were treated at an HVH-ECMO. Multidisciplinary care pathways, including those among surgery, cardiology, and critical care, may influence CS management. Further studies are needed to characterize long-term outcomes of regionalization and ensure equitable access for all populations.

Advisory Panel Guidance on Minimum Retesting Intervals for Lab Tests

What Is the Issue? Lab test overuse can contribute to further unnecessary follow-up and testing, negative patient experiences, potentially inappropriate treatments, and the inefficient use of health care resources. One review of lab testing in Canada found that around 22% of blood tests were likely unnecessary. One strategy to address lab test overuse is to establish minimal retesting intervals that can be implemented in medical laboratories to help identify and manage potentially inappropriate lab test requests. Minimum retesting intervals suggest the minimum time before a test should be repeated based on the biochemical properties of the test and the clinical situation in which it is used. They are intended to inform clinical decisions about repeat testing. The importance of lab resource stewardship is being addressed by Choosing Wisely Canada through Using Labs Wisely, a consortium of more than 150 hospitals committed to driving the appropriate use of lab testing in Canada. The hospitals participating in Using Labs Wisely identified a need for guidance on minimum retesting intervals for commonly used lab tests. What Did We Do? Choosing Wisely Canada and CADTH partnered to convene an independent time-limited advisory panel to develop consensus-based recommendations for minimum retesting intervals for 7 commonly used lab tests (antinuclear antibody [ANA], B-type natriuretic peptide [BNP] and N-terminal pro b-type natriuretic peptide [NT-proBNP], Hemoglobin A1C, lipase, lipid panel, serum protein electrophoresis [SPEP], and thyroid stimulating hormone [TSH]) in prespecified patient populations. The advisory panel included core and specialist members who were recruited from across Canada. The 7 core advisory panel members brought together expertise in laboratory medicine, family practice, and patient lived experience. Seven additional specialist members brought expertise in endocrinology, cardiology, pediatric cardiology, rheumatology, hematology oncology, gastroenterology, and general internal medicine. The Advisory Panel on Minimum Retesting Intervals considered patient group input, evidence from focused literature reviews, equity considerations, and clinical expertise. Through facilitated discussion, they reached consensus on the recommendations for minimum retesting intervals. Following external feedback, the recommendations for BNP and NT-proBNP and lipid panels were removed, and this document includes recommendations for minimum retesting intervals for 5 lab tests. These are not recommendations for repeat testing. They are recommendations that if testing is undertaken, it should not be repeated sooner than the indicated intervals. They are not intended to replace clinical judgment as there may be exceptions in which the recommendations do not apply. What Is the Potential Impact? The recommendations on minimum retesting intervals can support the hospitals participating in Choosing Wisely Canada’s Using Labs Wisely program in their effort to reduce unnecessary lab tests and their impact on patients, providers, health systems, and the environment. The recommendations may also be relevant to community and hospital lab stewardship efforts and may address the appropriate use of the 5 lab tests by enabling changes in lab test ordering in both inpatient and outpatient settings.

Ischemic Stroke and Reduced Left Ventricular Ejection Fraction: A Multidisciplinary Approach to Optimize Brain and Cardiac Health.

Reduced left ventricular ejection fraction ≤40%, a known risk factor for adverse cardiac outcomes and recurrent acute ischemic stroke, may be detected during an acute ischemic stroke hospitalization. A multidisciplinary care paradigm informed by neurology and cardiology expertise may facilitate the timely implementation of an array of proven heart failure-specific therapies and procedures in a nuanced manner to optimize brain and cardiac health.

Exploring the impact of cardiologists expertise on publication metrics

BackgroundIn the field of academic cardiology, the assessment of an author's scholarly impact and professional progression heavily relies on publications and citations. This study investigates whether specific cardiology expertise correlates with accelerated professional growth. MethodsUsing data from the 2023 European Society of Cardiology congress, 948 faculty attendees with an h-index of 30 or higher were analyzed. Expertises were categorized into six groups, and their association with publications and citations peaks was explored. ResultsInterventional cardiologists exhibited the highest annual publication peak, followed by imaging and electrophysiology experts. However, no significant differences were observed in citation peaks among expertise groups. While imaging experts initially appeared to reach citation peaks faster, this effect diminished after statistical adjustments. Additionally, holding multiple expertise areas prolonged the time to reach publication and citation peaks by approximately six years. ConclusionThis study underscores the influence of expertise in interventional cardiology on publication peaks but suggests that citation peaks and career progression velocity remain unaffected by expertise type. Furthermore, it highlights that holding multiple areas of expertise slowers the attainment of career peak for scholarly authors.

Intravascular ultrasound use in peripheral arterial and deep venous interventions: Multidisciplinary expert opinion from SCAI/AVF/AVLS/SIR/SVM/SVS

Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable’s aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.

HEALTH PRIORITIES ALIGNED DECISION MAKING FOR DISCRETE DECISIONS

Abstract The outcomes that establish the evidence-base and frame expectations for discrete interventions, primarily survival and disease-specific markers, may not be the outcomes older adults with multiple chronic conditions (MCCs) prioritize. An advisor group consisting of 6 health professionals with expertise in geriatrics, cardiology, vascular surgery and decision-making plus a panel of patient stakeholders created a decision-making framework titled ‘health priorities identification – discrete intervention decision’ (HPI-DID) process. This study aimed to refine the HPI-DID process using revascularization for peripheral arterial disease (PAD) as an exemplar procedure through eliciting feedback on the HPI-DID process from patients and caregivers. Seven older adults who recently underwent a revascularization procedure for PAD or their caregivers took part in one-to-one interviews with JB and SS. During interviews, participants were asked to verbalize or ‘think-aloud’ their thoughts while reviewing and performing each component of the health priorities process and probed what could be added or cut to improve the procedure-related communication and decision-making process. Participant feedback resulted in structural changes to the process. Font size was increased and specific words were bolded. Three additional tables detailing expected benefits, tradeoffs and complications from the procedure and their expected durations were added. The mean percentage of patients who experience these outcomes is now also listed. We will conduct a pilot trial to evaluate the feasibility and acceptability of our refined HPI-DID process with clinical interventionalists and older patients with MCCs considering revascularization for PAD.

Opportunistic identification of atrial fibrillation during unscheduled contact with emergency ambulance services in England: a qualitative exploration

Abstract Background Atrial fibrillation (AF) is an important risk factor for stroke which commonly affects people attended by Emergency Medical Services (EMS). There may be an opportunity for. EMS clinicians to find new incidental cases of AF suitable for oral anticoagulation (OAC) amongst the population who do not require conveyance to hospital following urgent ambulance review. Purpose This study explored whether it was acceptable to propose a formal pathway for identification and subsequent referral of non-conveyed EMS patients with incidental AF to their general practitioner (GP) for consideration of OAC prescription. The perspectives of patients, paramedics, and field experts were included. Methods This qualitative study included four online focus groups involving 18 members of the public and one-to-one online interviews in England with 11 health care and service providers (6 paramedics, 5 field experts providing multiple expertise in cardiology, general practice, public health, academic research, healthcare policy, and primary care commissioning) between June and September 2022. A semi-structured topic guide was used, with purposive sampling to maximise the diversity of perspective and experience in all participant groups. Data were audio-recorded, transcribed anonymously and analysed thematically. Results All participant groups supported formalising the opportunistic detection of AF during EMS review, but each had concerns and caveats. Of paramount concern to all groups was that any change in practice must not create delays in the emergency response system since incidental AF is non-urgent and other community pathways are in place for detection and management. Public participants were also concerned about how the diagnosis would be communicated to the patient, and opinion was split between whether this should be ‘on the scene’ or in a subsequent GP appointment. Paramedics reported that they frequently identify incidental AF, but that there is variation in practice regarding whether (and how) this is communicated to the GP. There was a concern that the finding of AF was not easily visible within the existing EMS report and may be missed. Paramedics also focussed on safety-netting of patients not being conveyed to hospital and of a need for an ‘active’ reporting process to ensure that the finding of AF was acted upon. In general, field experts felt that a formal pathway would be useful but relatively low impact, and favoured a simple intervention that did not overly complicate existing AF pathways. Conclusions There is support amongst the public and professionals for the development of a formal pathway to ensure ongoing follow-up and care for people with AF incidentally detected in the community by EMS. This novel case finding opportunity has the potential to improve AF detection, oral anticoagulation rates, and reduce the risk of stroke.

Relationship between care speciality and atrial fibrillation outcomes in the GARFIELD-AF registry

Abstract Background Atrial fibrillation (AF) is associated with cardio-embolic stroke. It remains unclear whether AF outcomes are related to the care speciality at AF diagnosis. Purpose To explore associations between the care speciality at AF diagnosis and the risks of clinical outcomes in newly diagnosed AF patients. Methods GARFIELD-AF is an international registry of consecutively recruited newly diagnosed AF patients with ≥1 stroke risk factors. Participants were divided based on the care specialty at AF diagnosis: primary care, cardiology, or other medical specialties (internal medicine, neurology, or geriatrics). The follow-up period was from the date of enrolment, truncated at first event occurrence, death, loss to follow-up, or two years after enrolment, whichever occurred first. Hazard ratios for the associations of care speciality with selected clinical outcomes were estimated using Cox proportional-hazards models adjusted for the confounding factors, which included demographics, AF type, medical history, baseline comorbidities, and treatment information. Results The study population comprised 52,011 prospectively enrolled GARFIELD-AF patients with available care speciality and follow-up information. Most participants were diagnosed by a cardiology specialist (n=34,172, 65.7%), and fewer by other medical specialists (n=10,443, 20.1%) or primary care practitioners (n=7,396, 14.2%). Patients diagnosed by cardiologists were on average younger, had lower BMI, and were more likely to have paroxysmal AF when first diagnosed. These patients also received NOAC more frequently (30.1%), compared to patients diagnosed by other medical specialties (24.2%) or primary care practitioners (20.4%, Table 1). CHA2DS2-VASc and HAS-BLED scores were similar across care specialities. The proportion of patients treated by a cardiologist differed substantially between countries, ranging from 9% in Finland to 97% in Egypt. Patients cared for by non-cardiology medical specialties had a greater risk of all-cause mortality (HR 1.23, 95%CI 1.08 to 1.39), non-cardiovascular mortality (HR 1.31, 1.12 to 1.53) and non-haemorrhagic stroke/systemic embolism (HR 1.45, 1.18 to 1.80) compared with participants cared for by a cardiologist. Patients treated by primary care practitioners had a lower all-cause mortality risk compared with those diagnosed by cardiologists (HR 0.86, 0.74 to 0.99) (Figure 1). Conclusions Overall, patients developing new AF were most often diagnosed by cardiologists, but substantial regional variation existed. Patients diagnosed by cardiologists received NOACs more frequently compared to patients diagnosed from other care specialties. Patients treated by non-cardiology medical specialities experienced a comparatively greater risk of death and non-haemorrhagic stroke. Cardiology expertise could have important implications for the care of newly diagnosed AF patients.Figure 1Table 1

Identification of abnormal ventricular asymmetry in 2nd trimester fetal ultrasound using artificial intelligence

Abstract Introduction Prenatal ultrasound screening for congenital heart disease (CHD) suffers from poor detection yield (10%-56%)[1, 2], with a strong impact on neonatal morbidity and mortality. The need for expertise in fetal cardiology and the high volume of screening cases limit the current detection rates. Computer-assisted prenatal screening could support clinicians in improving diagnostic yield, including for abnormal ventricular asymmetry, which is often hard to discriminate from physiological asymmetry. Here we aim at evaluating a deep neural network (DNN) for detection of abnormal ventricular asymmetry, which can be linked to multiple types of CHD, including coarctation of the aorta, pulmonary or aortic valve stenosis, ventricular hypoplasia or univentricular heart. Purpose To determine if a novel DNN can identify cases of abnormal ventricular asymmetry in 2nd trimester fetal ultrasound videos. Methods We used as an endpoint the presence of any abnormality causing a significantly abnormal asymmetry of the ventricles as seen in the fetal ultrasound. Consecutive patients who had an echocardiography performed at one center were included retrospectively starting from 2022, January 1st. Inclusion criteria were single pregnancy between 18 and 25 weeks of gestation. To have a high number of positive patients, patients were included separately if they were expected to be positive (n=35) or negative (n=75) to the endpoint, based on their medical record. Each case was reviewed by one of two physicians expert in fetal echocardiography interpretation to confirm the presence or absence of the endpoint. For each patient, a single video showing an interpretable four chamber view was selected. Patients with no such video were excluded. The DNN takes as input fetal ultrasound videos, and predicts the absence or presence of the endpoint for each video. If its confidence is low, the DNN predicts an "inconclusive" output instead. The DNN has a ResNet-50 architecture[3] adapted to videos and was trained on data from patients not included in the evaluation. The detection performance of the DNN and the proportion of conclusive outputs were assessed. Results Overall, 37 positive and 66 negative ultrasound videos were included. The DNN achieved an AUC of 75.5%, a sensitivity of 71.4% (54.9-83.7, 95%CI) and a specificity of 64.4% (51.7-75.4, 95%CI) in identifying cases of abnormal ventricular asymmetry, after excluding inconclusive diagnosis. The DNN predicted a conclusive diagnosis in 91.3% of cases. Conclusion A DNN could accurately identify cases of abnormal ventricular asymmetry in fetal heart ultrasound videos. Importantly, this evaluation was performed in a population of patients who had an echocardiogram, and which therefore contains more abnormal cases compared to patients undergoing standard screening. This work lays the ground for diagnostic support to enable a more efficient, accurate, and scalable analysis of fetal heart ultrasounds.

Sports cardiology: A glorious past, a well-defined present, a bright future.

The attention towards sports cardiology has dramatically grown after the introduction of preparticipation screening and the need for specific education on electrocardiogram interpretation in athletes, given the differences between athletes and the general population. The present article stresses the need for specific skills, knowledge, and clinical expertise in sports cardiology, which are essential for appropriately screening competitive athletes to prevent sudden cardiac death and avoid overdiagnosis. However, disqualification from sports competitions may lead to sports inactivity, and athletes may enter a gray zone where little or no information is provided about what they can or cannot do to stay active. However, modern sports cardiology cannot neglect the patient's needs and the importance of the safe practice of regular exercise. In this context, the personalized exercise prescription plays a crucial role in the core curriculum and the clinical activity of professionals involved in sports cardiology programs. Given its specificities, sports cardiology requires a formal education plan for medical school students and all residents. Additional education and practice are required for young colleagues who want to focus their professional lives on sports cardiology. The future directions of emerging modern sports cardiology should not neglect the importance of a scientific community that works together, designing multicenter international outcomes-based research to address the many remaining areas of uncertainty.

Abstract 11919: Differences in the Documentation of Atrial Fibrillation Symptoms in Electronic Health Records Between Patients With and Without Comorbid Heart Failure

Introduction: Atrial fibrillation (AF) causes burdensome symptoms that impact quality of life. One in four AF patients have comorbid heart failure (HF). Understanding whether comorbid HF impacts AF symptom experiences can guide interventions for symptom management. Objective: We aimed to investigate whether patients with AF and comorbid HF will have different symptoms compared to those with AF only. Methods: We used structured and unstructured data (i.e., clinical notes) from electronic health records of patients in a large, urban health system between 2010-2010. We created two cohorts: (1) AF only, and (2) AF and HF. We extracted symptoms from notes written immediately before a catheter ablation to treat AF because of high symptom enrichment in ablation consultation notes compared to general progress notes. To extract symptoms, we applied a natural language processing algorithm with high performance on the corpus of notes (precision=0.73, recall=0.93, F-score=0.81). A team of cardiologists and nurses with cardiology expertise chose 10 symptoms to evaluate. We used Chi squared tests to compare differences in the prevalence of documented symptoms between cohorts. We further characterized each cohort using the structured demographics data. Results: Patients with AF only (n=504) had a mean age of 65.1 (SD 10.5) years, 33.3% were documented as female, and 14.3% documented as non-White. Patients with AF and HF (n=575) had a mean age of 69.4 (SD 12.0) years, 38.8% were documented as female, and 23.5% documented as non-White. The HF and AF cohort had a significantly higher prevalence of 6 symptoms (Table 1). The AF only cohort had a significantly higher prevalence of one symptom (palpitations). Conclusions: There are clear differences in the prevalence of symptoms between cohorts, with HF patients experiencing greater symptom burden overall. Future work exploring differences, such as through symptom clusters, will further illuminate differences in symptom experiences.

New trio for interventional cardiology submissions.

All correspondence relating to this article should be sent to cardiopulse@unicatt.it. From September 2022, a new team of three will be bringing their expertise in interventional cardiology to the process of sifting submissions and shepherding manuscripts for publication in the European Heart Journal (EHJ). Incoming deputy editor Emanuele Barbato, associate editors Tommaso Gori and Margaret McEntegart will take up a two-year tenure from outgoing deputy editor Javier Escaned MD, PhD, from Spain, and associate editors Julinda Mehilli MD, from Germany and Farouc Jaffer, MD, PhD, of the United States (Figure 1). Prof. Barbato graduated in medicine in 1997 and later obtained board certification in Cardiology at the University of Naples Federico II, in Italy. Whilst he was still a medical student, he completed a short-stay research fellowship at Duke University in North Carolina, US. He completed his PhD in Cardiovascular Pathophysiology at the University Tor Vergata in Rome, Italy in 2006. In the early years of the Millennium, he was a clinical research fellow at the Cardiovascular Research Center of Aalst, Belgium, where he eventually became Co-Director of the Cardiovascular Centre. In 2018, he became full Professor of Cardiology at the Department of Advanced Biomedical Sciences of the University of Naples Federico II. In 2022, he was appointed Full Professor of Cardiology at the Department of Clinical and Molecular Medicine of the Sapienza University of Rome.

Managing CHD in Tertiary NICU in Collaboration with a Cardiothoracic Center.

Increasingly non-cardiac tertiary neonatal intensive care units (NCTNs) manage newborns with CHD prior to planned transfer to specialist cardiac surgical centres (SCSC). It improves patient flow in SCSCs, enables families to be nearer home, and improves psychological well-being Parker et al. (Evaluating models of care closer to home for children and young people who are ill: a systematic review, 2011). This practice has gradually increased as the number of SCSCs has decreased. This study examines the effectiveness of this expanding practice. The management provided, length of stay in the NCTN and outcomes are described for one UK NCTN situated at a significant distance from its SCSC. A retrospective observational study of cardiac-related admissions to a NCTN between January 2010 and December 2019 was conducted. 190 neonates were identified: 41 had critical CHD; 64 had major CHD. The cohort includes babies with a wide range of cardiac conditions and additional complexities. 23.7% (n = 45) required transfer to a specialist center after a period of stabilization and growth ranging from several hours to 132days. 68% (n = 130) were discharged home or repatriated to a local NICU. Of the remaining 15 babies, 13 were transferred to other specialties including the hospice. Two died on NICU. The mortality was consistent with the medical complexity of the group Best and Rankin (J Am Heart Assoc 5:e002846, 2016), Laas et al. (BMC Pediatr 17:124, 2017). 8.9% (n = 17) died before age 2. Nine babies had care redirected due to an inoperable cardiac condition or life-limiting comorbidities. Our study demonstrates a complex neonatal cohort with CHD can be managed effectively in a NCTN, supporting the current model of care. The NCTN studied was well supported by pediatricians with expertise in cardiology alongside visiting pediatric cardiologists.

Deep Learning for Automated Echocardiogram Analysis

In the fight of heart disease (the #1 global killer), Left ventricular ejection fraction (EF) calculated via echocardiography plays crucial role for disease diagnosis and treatment because EF can distinguish heart failure from normal cardiac function. However, traditional EF calculation is a time-consuming manual process with high variability ‒ a single routine echocardiogram generates about 10–50 videos (~3,000 images), coupled with the limited capacity to analyze such large dataset by human experts often results in misdiagnosis. This project aimed to develop transparent and interpretable deep learning pipeline for automated echocardiogram analysis to calculate EF for quick assessment of cardiac function. Using the EchoNet dataset, five PyTorch deep learning models were trained to automatically calculate EF achieving mean error rates that ranged from 14-16%, comparable to that of expert cardiac sonographers, and significantly outperformed qualitative analysis by physicians (~30% error rate). Among the five models, MobileNet was identified as the best deep learning model for web application and portable devices; therefore, it was deployed as a web-based app through AWS, standalone PC, and Raspberry Pi, enabling upload and analyze echocardiogram videos and obtain EF calculation results within seconds. Such automated echocardiogram analysis can dramatically speed up image analysis, reduce the burden on cardiologists, eliminate inter-observer variability, hence democratize echocardiography by enabling non-experts to quickly and accurately assess cardiac functions at point of care even in cardiology expertise limited rural areas and developing countries. Future work includes improving these models with additional data and adapting the app for handheld ultrasound devices.

Deep learning approach of murmur detection using Cochleagram

Primary detection of heart abnormalities can reduce sudden death due to heart related diseases to a great extent. A low cost noninvasive phonocardiogram (PCG) signal based heart murmur detection system can serve the purpose partially. In this work, initially the heart sound signal is segmented using an unsupervised technique. After that, deep neural network (DNN) architectures with three hidden layers have been proposed to classify the input heart sound signal as normal or murmur class using 64 dimensional acoustic features. Total 3482 heart sound cycles from a standard database have been used to train and test the proposed DNN model. The usual evaluation matrices of sensitivity, specificity, precision, F1-score and accuracy have been derived to evaluate the performance of the classifier. After studying five different DNN models we have achieved the highest F1-score of 98.31% and accuracy of 98.33% for the murmur class. This murmur detection system can be extremely useful in rural health cares and small hospitals to assist the general physicians in assessing heart diseases without having expertise in cardiology.

An Overview of Cardio-Oncology, a New Frontier to Be Explored.

Advances in cancer treatments have led to an increasing number of cancer survivors, but also high rates of short- and long-term cardiovascular (CV) toxicities. The number of new cancer drugs is constantly increasing, and the uncertain CV toxicities of these drugs make long-term care and monitoring difficult. Moreover, traditional type I and type II cardiotoxicities may not be applicable to all of these agents. Multidisciplinary care with expertise in oncology, cardiology and other related specialties is required to mitigate cancer therapeutics-related cardiovascular dysfunction (CTRCD). The aim of this review is to provide an overview of the main CTRCD, risk assessment, early diagnosis, and strategies for the prevention and management of patients receiving cancer therapies. There are still unmet needs for cardio- oncology researchers with regards to early detection measures, better treatment strategies, better follow-up protocols, and better management of CTRCD. Experts in cardiology, oncology, hematology, and radio-oncology should thus work closely in an attempt to foster patient awareness and research in this field, as well as call for support from public and industrial sources to initiate pivotal clinical trials to solve these unmet needs.

Counseling for fetal heart disease-current standards and best practice.

Congenital heart disease (CHD) is the most common cause of major congenital anomalies affecting newborns. Prenatal detection of CHD has been improving continuously during the last two decades due to technical advances and thus optimized fetal cardiac imaging. Besides the in-utero diagnosis of CHD effective parental counseling is an integral part of any Fetal Cardiology Program. However, studies on the most effective techniques are scarce, as well as data on empirical assessment of counseling and its effectiveness. In this review article, we summarize current guidelines from different international associations and societies. We provide an updated literature overview evaluating current standards of counseling with regard to parental needs. This includes ethical aspects, counseling for univentricular disease and in-utero cardiac interventions. We discuss our method to assess counseling success for fetal heart defects by exploring different analytical dimensions that may be considered helpful in order to improve efficacy. Finally, we present a proposal of how to optimize a setting for counseling based on the current literature and our own data. In summary, parental counseling for fetal heart disease is complex and multidimensional. Significant expertise in fetal cardiology and physiology, potential progression of CHD, postnatal treatment strategies and knowledge of long-term sequelae is necessary. A structured approach, together with continuous improvement of communicative skills, may lead to more effective counseling for parents following a diagnosis of CHD in the fetus.

Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland.

Background: Following the spread of the coronavirus disease 2019 (COVID-19) pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). In the absence of trials, evidence for treatment remains scarce.Purpose: To develop best practice recommendations for the diagnosis and treatment of children with PIMS-TS in Switzerland. It is acknowledged that the field is changing rapidly, and regular revisions in the coming months are pre-planned as evidence is increasing.Methods: Consensus guidelines for best practice were established by a multidisciplinary group of Swiss pediatric clinicians with expertise in intensive care, immunology/rheumatology, infectious diseases, hematology, and cardiology. Subsequent to literature review, four working groups established draft recommendations which were subsequently adapted in a modified Delphi process. Recommendations had to reach >80% agreement for acceptance.Results: The group achieved agreement on 26 recommendations, which specify diagnostic approaches and interventions across anti-inflammatory, anti-infectious, and support therapies, and follow-up for children with suspected PIMS-TS. A management algorithm was derived to guide treatment depending on the phenotype of presentation, categorized into PIMS-TS with (a) shock, (b) Kawasaki-disease like, and (c) undifferentiated inflammatory presentation.Conclusion: Available literature on PIMS-TS is limited to retrospective or prospective observational studies. Informed by these cohort studies and indirect evidence from other inflammatory conditions in children and adults, as well as guidelines from international health authorities, the Swiss PIMS-TS recommendations represent best practice guidelines based on currently available knowledge to standardize treatment of children with suspected PIMS-TS. Given the absence of high-grade evidence, regular updates of the recommendations will be warranted, and participation of patients in trials should be encouraged.

Mending Broken Hearts

Mending Broken Hearts