New Guidelines Research Articles

Improved Risk Stratification of Patients With Brugada Syndrome by the New Japanese Circulation Society Guideline - A Multicenter Validation Study.

The new guideline (NG) published by the Japanese Circulation Society (JCS) places emphasis on previous arrhythmic syncope and inducibility of ventricular fibrillation (VF) by ≤2 extrastimuli during programmed electrical stimulation (PES) for deciding the indication of an implantable cardioverter-defibrillator in patients with Brugada syndrome (BrS). This study evaluated the usefulness of the NG and compared it with the former guideline (FG) for risk stratification of patients with BrS.Methods and Results:This was a multicenter (7 Japanese hospitals) retrospective study involving 234 patients with BrS who underwent PES at baseline (226 males; mean age at diagnosis: 44.9±13.4 years). At diagnosis, 46 patients (20%) had previous VF, 100 patients (43%) had previous syncope, and 88 patients (37%) were asymptomatic. We evaluated the difference in the incidence of VF in each indication according to the new and FGs. During the follow-up period (mean: 6.9±5.2 years), the incidence of VF was higher in patients with Class IIa indication according to the NG (NG: 16/45 patients [35.6%] vs. FG: 16/104 patients [15.4%]), while the incidence of VF in patients with other than class I or IIa indication was similarly low in both guidelines (NG: 2/143 patients [1.4%] vs. FG: 2/84 patients [2.4%]). This study validated the usefulness of the NG for risk stratification of BrS patients.

A16939 Reliability of Triage Blood Pressure in the Emergency Department for Determination of Uncontrolled Hypertension

Objectives: In November 2017, the American Heart Association (AHA) revised their hypertension (HTN) guidelines, decreasing the criteria for diagnosis and target for blood pressure (BP) control to 130/80 mmHg. This change has markedly increased the number of Americans who are affected by HTN and the proportion whose BP will be considered uncontrolled. There is increasing emphasis in emergency departments (EDs) on improving management of chronic diseases such as HTN making the reliability of BP measurement important. The objective of this study was to evaluate the reliability of ED BP measurement for determining uncontrolled HTN based on the new guideline (NG), using repeat measurement in the ED via BpTRU as the gold standard. Methods: Data were collected as part of an on-going, prospective HTN registry for 338 participants who visited one of our three urban EDs and were identified as having a previous diagnosis of HTN. In addition to demographic data, triage BP was recorded along with a repeat BP using the BpTRU device. Descriptive analysis was performed using SAS version 9.4 and Tableau version 10.4. Results: Of the 338 participants (mean age 45 years [13.4], 37 % male, 95 % African American; mean BP at triage = 163/98 mm Hg; mean BP by BpTru = 151/96 mm Hg), 295 (87.3%) were considered uncontrolled using triage BP by OG compared to 313 (92.6%) under NG. Measurements collected using BpTRU showed that 219 (64.8%) were uncontrolled by OG, while 263 (77.8%) were uncontrolled using NG criteria. Conclusion: Based on NG criteria, more ED patients were found to have uncontrolled BP. However, use of BpTRU reduced the proportion with a BP above established criteria, suggesting that this approach to evaluation of patients with HTN may be beneficial in the effort to address the burden of chronic disease management.

Can Image-Defined Risk Factors Predict Surgical Complications in Localized Neuroblastoma?

Image-defined risk factors (IDRFs) have been propounded for predicting the surgical risks associated with localized neuroblastoma (NB) since 2009. In 2011, a new guideline (NG) for assessing IDRFs was published. According to the NG, the situation in which "the tumor is only in contact with renal vessels," should be considered to be "IDRF-present." Previously, this situation was diagnosed as "IDRF absent." In this study, we evaluated the IDRFs in localized NB patients to clarify the predictive capability of IDRFs for surgical complications, as well as the usefulness of the NG. Materials and A total of 107 localized patients with NB were included in this study. The enhanced computed tomography and magnetic resonance images from the time of their diagnoses were evaluated by a single radiologist. We also analyzed the association of clinical factors, including the IDRFs (before and after applying the NG), with surgical complications. Of the 107 patients, 33 and 74 patients were diagnosed as IDRF-present (OP group), and IDRF-absent (ON group) before the NG, respectively. According to the NG, there were 76 and 31 patients who were classified as IDRF-present (NP group) and IDRF absent (NN group), respectively. Thus, 43 (40%) patients in the ON group were reassigned to the NP group after the NG. Surgical complications were observed in 17 of 82 patients who underwent surgical resection. Of the patients who underwent secondary operations, surgical complication rates were 55% in the OP group and 44% in the NP group. According to a univariate analysis, non-INSS 1, IDRFs before and after the NG and secondary operations were significantly associated with surgical complications. In a multivariate analysis, non-INSS 1 status and IDRFs after the NG were significantly associated with surgical complications.

Validity of image-defined risk factors in localized neuroblastoma: A report from two centers in Western Japan

BackgroundJapanese Neuroblastoma Study Group (JNBSG) has been employing image-defined risk factors (IDRFs) since 2010. However, the report from INRG in 2011 supplemented description stating that isolated contact is considered to be IDRF-positive only in renal vessels. The aim of this study was to evaluate the validity of IDRFs by comparing the previous (PG) and new guidelines (NG). MethodsIDRFs of patients with localized neuroblastoma treated at two centers in Western Japan from 2002 to 2013 were retrospectively reviewed by radiologists. Results47 neuroblastomas (abdomen 38, pelvis 2, mediastinum 7) were evaluated. For abdominal neuroblastomas, IDRFs were present in 15/38 (39.5%) using PG and in 31/38 (81.6%) using NG. Moreover, the IDRF-positive rate increased from 26.7% (4/15) to 80.0% (12/15) in 15 cases diagnosed during mass screening. Of the IDRF-positive cases, complete primary resection was achieved in 2/15 (13.3%) using PG and 17/31 patients (54.8%) using NG. There were two major surgical renal complications in the IDRF-positive cases based on the use of either guidelines, and the specificity decreased from 64% to 19%. ConclusionsAccording to NG, the IDRF-positive rate increased, and the resection rate decreased. NG may overestimate surgical risks, leading to unnecessary chemotherapy and a prolonged hospital stay.