Testing For Risk Stratification Research Articles

Echo-derived peak cardiac power output-to-left ventricular mass with cardiopulmonary exercise testing predicts outcome in patients with heart failure and depressed systolic function.

Peak cardiac power output-to-mass (CPOM) represents a measure of the rate at which cardiac work is delivered respect to the potential energy stored in left ventricular (LV) mass. We studied the value of CPOM and cardiopulmonary exercise test (CPET) in risk stratification of patients with heart failure (HF). We studied 159 patients with chronic HF (mean rest LV ejection fraction 30%) undergoing CPET and exercise stress echocardiography. CPOM was calculated as the product of a constant (K = 2.22 × 10-1) with cardiac output (CO) and the mean blood pressure (MBP), divided by LV mass (M), and expressed in the unit of W/100 g: CPOM = [K × CO (L/min) × MBP (mmHg)]/LVM(g). Patients were followed-up for the primary endpoint, including all-cause death, ventricular assist device implantation, and heart transplantation, and the secondary endpoint that comprised hospitalization for HF. In multivariate Cox regression analyses, peak CPOM was selected as the most powerful independent predictor of both primary and secondary endpoint [hazard ratio (HR) 0.004, 95% confidence interval (CI) 0.004-0.3; P = 0.002 and HR 0.09, 95% CI 0.02-0.55; P = 0.009]. Sixty-month survival free from the combined endpoint was 85% in those exhibiting oxygen consumption (VO2) > 14 mL/min/kg and peak CPOM > 0.6 W/100 g. Peak VO2 ≤ 14 mL/min/kg provided incremental prognostic value over demographic and clinical variables, brain natriuretic peptide, and resting echocardiographic parameters (χ2 from 58 to 64; P = 0.04), that was further increased by peak CPOM ≤ 0.6 W/100 g (χ2 77; P < 0.001). Peak CPOM and peak VO2 showed independent and incremental prognostic values in patients with chronic HF.

Differentiating between benign and malignant thyroid nodules: An evidence-based approach in general practice

The widespread use of imaging techniques has led to more frequent detection of thyroid nodules, and while the majority are benign, the risk of malignancy in an adult ranges from 7% to 15%. General practitioners (GPs) must be able to evaluate thyroid nodules and refer cases when appropriate. The aim of this article is to bring GPs up to date on the evidence-based management of thyroid nodules, with specific focus on neoplastic nodules, while highlighting significant changes in the 2015 American Thyroid Association guidelines. Thyroid nodules frequently occur in the general population. Differentiating between a benign and malignant nodule can be challenging, and community guidelines have standardised investigation, management and follow-up procedures. The key tests for risk stratification of thyroid nodules include serum thyroid-stimulating hormone testing, ultrasonography and fine-needle aspiration. GPs should be aware of the latest evidence-based recommendations for the appropriate management of a thyroid nodule.

Clinical Proof-of-concept of a Novel Platform Utilizing Biopsy-derived Live Single Cells, Phenotypic Biomarkers, and Machine Learning Toward a Precision Risk Stratification Test for Prostate Cancer Grade Groups 1 and 2 (Gleason 3 + 3 and 3 + 4)

ObjectiveTo examine the ability of a novel live primary-cell phenotypic (LPCP) test to predict postsurgical adverse pathology (P-SAP) features and risk stratify patients based on SAP features in a blinded study utilizing radical prostatectomy (RP) surgical specimens. MethodsTwo hundred fifty-one men undergoing RP were enrolled in a prospective, multicenter (10), and proof-of-concept study in the United States. Fresh prostate samples were taken from known areas of cancer in the operating room immediately after RP. Samples were shipped and tested at a central laboratory. Utilizing the LPCP test, a suite of phenotypic biomarkers was analyzed and quantified using objective machine vision software. Biomarkers were objectively ranked via machine learning-derived statistical algorithms (MLDSA) to predict postsurgical adverse pathological features. Sensitivity and specificity were determined by comparing blinded predictions and unblinded RP surgical pathology reports, training MLDSAs on 70% of biopsy cells and testing MLDSAs on the remaining 30% of biopsy cells across the tested patient population. ResultsThe LPCP test predicted adverse pathologies post-RP with area under the curve (AUC) via receiver operating characteristics analysis of greater than 0.80 and distinguished between Prostate Cancer Grade Groups 1, 2, and 3/Gleason Scores 3 + 3, 3 + 4, and 4 + 3. Further, LPCP derived-biomarker scores predicted Gleason pattern, stage, and adverse pathology with high precision—AUCs>0.80. ConclusionUsing MLDSA-derived phenotypic biomarker scores, the LPCP test successfully risk stratified Prostate Cancer Grade Groups 1, 2, and 3 (Gleason 3 + 3 and 7) into distinct subgroups predicted to have surgical adverse pathologies or not with high performance (>0.85 AUC).

Assessment of Risk Stratification and Genetic Testing of Patients Referred for Polyposis to a High-Risk Colorectal Cancer Prevention Program

Assessment of Risk Stratification and Genetic Testing of Patients Referred for Polyposis to a High-Risk Colorectal Cancer Prevention Program

Combining noninvasive risk stratification parameters improves the prediction of mortality and appropriate ICD shocks.

Sudden cardiac death (SCD) results from a complex interplay of abnormalities in autonomic function, myocardial substrate and vulnerability. We studied whether a combination of noninvasive risk stratification tests reflecting these key players could improve risk stratification. Patients implanted with an ICD in whom 24-hr holter recordings were available prior to implant were included. QRS fragmentation (fQRS) was selected as measure of myocardial substrate and a high ventricular premature beat count (VPB >10/hr) for arrhythmic vulnerability. From receiver operating characteristics analysis, detrended fluctuation analysis (DFA), turbulence slope, and deceleration capacity were selected for autonomic function. Adjusted Cox regression analysis with comparison of C-statistics was performed to predict first appropriate shock (AS) and total mortality. A total of 220 patients were included in the analysis with an overall follow-up of 4.3±3.1years. A model including VPB >10/hr, inferior fQRS, and abnormal nonedited DFA was the best for prediction of AS after 1year of follow-up with a trends toward improvement of the C-statistics compared to baseline (p=0.055). The risk increased significantly with every abnormal test (HR 1.793, 95%CI 1.255-2.564). A model including fQRS in any region and abnormal edited DFA was the best for prediction of mortality after 3years of follow-up with significant improvement of the C-statistics (p=0.023). Each abnormal test was associated with a significant increase in mortality (HR 5.069, 95%CI 1.978-12.994). Combining noninvasive risk stratification tests according to their physiological background can improve the risk prediction of SCD and mortality.

Exercise in Congenital Heart Disease

Congenital heart disease (CHD) patients tend to exercise less than their peers without heart disease. These patients often have exercise hesitancy or are not appropriately encouraged to exercise by their primary cardiologists. Regular exercise in the CHD population has been shown to increase fitness and lessen the incidence of obesity. There are positive psychosocial benefits of regular exercise including decreased mood disorders, improved academic performance, and ultimately improved quality of life. As physical activity is increasingly emphasized, a purposeful approach utilizing cardiopulmonary exercise testing for risk stratification and establishment of a baseline level of fitness is often helpful. Once exercise testing is complete, cardiopulmonary rehabilitation has been shown to improve measures of physical and mental fitness and should be considered in CHD patients in need of assistance with exercise.

Cardiopulmonary Exercise Testing for Surgical Risk Stratification in Adults with Congenital Heart Disease.

Adult congenital heart disease (ACHD) patients often require repeat cardiothoracic surgery, which may result in significant morbidity and mortality. Currently, there are few pre-operative risk assessment tools available. In the general adult population, pre-operative cardiopulmonary exercise testing (CPET) has a predictive value for post-operative morbidity and mortality following major non-cardiac surgery. The utility of CPET for risk assessment in ACHD patients requiring cardiothoracic surgery has not been evaluated. Retrospective chart review was conducted on 75 ACHD patients who underwent CPET less than 12months prior to major cardiothoracic surgery at Children's Hospital of Wisconsin. Minimally invasive procedures, cardiomyopathy, acquired heart disease, single ventricle physiology, and heart transplant patients were excluded. Demographic information, CPET results, and peri-operative surgical data were collected. The study population was 56% male with a median age of 25years (17-58). Prolonged post-operative length of stay correlated with increased ventilatory efficiency slope (VE/[Formula: see text] slope) (P = 0.007). Prolonged intubation time correlated with decreased peak HR (P = 0.008), decreased exercise time (P = 0.002), decreased heart rate response (P = 0.008) and decreased relative peak oxygen consumption (P = 0.034). Post-operative complications were documented in 59% of patients. While trends were noted between post-operative complications and some measurements of exercise capacity, none met statistical significance. Future studies may further define the relationship between exercise capacity and post-operative morbidity in ACHD patients.

Prognostic significance of ventricular late potentials in patients with pulmonary sarcoidosis

Early detection of cardiac involvement in sarcoidosis is difficult but essential to achieve optimal treatment. Signal-averaged electrocardiography (SAECG) can detect subtle cardiac electrical abnormalities termed late potentials (LPs) and would be useful for the early diagnosis of cardiac involvement. This study aims to investigate the prognostic significance of LP in patients with pulmonary sarcoidosis. We prospectively studied 74 patients with pulmonary sarcoidosis without overt electrocardiographic abnormalities. All participants underwent SAECG, cardiac echocardiography, and 24-hour ambulatory Holter monitoring. Serum angiotensin-converting enzyme and B-type natriuretic peptide levels were also evaluated. We followed these patients for the evaluation of incidence of cardiac events including cardiac death, arrhythmias, and heart failure requiring hospital admission. Of the studied population, 29 patients (39.2%) had detectable LP. During a mean follow-up period of 9.8 years, 8 patients with LPs had cardiovascular events, including development of complete atrioventricular block (n = 4), ventricular tachycardia (n = 2), and heart failure (n = 2). Meanwhile, only 1 of 45 patients without LP developed cardiac event (heart failure). Multivariate analyses revealed that LPs were associated with an increased risk of developing cardiac events (hazard ratio 9.66; 95% confidence interval 1.20-78.01; P = .033) whereas age, sex, serum angiotensin-converting enzyme and B-type natriuretic peptide levels, number of premature ventricular contractions on 24-hour Holter monitoring, and echocardiographic parameters were not associated with subsequent cardiac events. SAECG might possibly be useful for the early detection of cardiac sarcoidosis and, if independently validated, could eventually be considered as a screening test for further risk stratification.

Contralateral parenchymal enhancement on dynamic contrast-enhanced MRI reproduces as a biomarker of survival in ER-positive/HER2-negative breast cancer patients

ObjectivesTo assess whether contralateral parenchymal enhancement reproduces as an independent biomarker for patient survival in an independent patient cohort from a different cancer institution.MethodsThis is a HIPAA-compliant IRB approved retrospective study. Patients with ER-positive/HER2-negative operable invasive ductal carcinoma and preoperative dynamic contrast-enhanced MRI were consecutively included between 2005 and 2009. The parenchyma of the breast contralateral to known cancer was segmented automatically on MRI and contralateral parenchymal enhancement (CPE) was calculated. CPE was split into tertiles and tested for association with invasive disease-free survival (IDFS) and overall survival (OS). Propensity score analysis with inverse probability weighting (IPW) was used to adjust CPE for patient and tumour characteristics as well as systemic therapy.ResultsThree hundred and two patients were included. The median age at diagnosis was 48 years (interquartile range, 42-57). Median follow-up was 88 months (interquartile range, 76-102); 15/302 (5%) patients died and 37/302 (13%) had a recurrence or died. In context of multivariable analysis, IPW-adjusted CPE was associated with IDFS [hazard ratio (HR) = 0.27, 95% confidence interval (CI) = 0.05-0.68, p = 0.004] and OS (HR = 0.22, 95% CI = 0.00-0.83, p = 0.032).ConclusionsContralateral parenchymal enhancement on pre-treatment dynamic contrast-enhanced MRI as an independent biomarker of survival in patients with ER-positive/HER2-negative breast cancer has been upheld in this study. These findings are a promising next step towards a practical and inexpensive test for risk stratification of ER-positive/HER2-negative breast cancer.Key points• High parenchymal-enhancement in the disease-free contralateral breast reproduces as biomarker for survival.• This is in patients with ER-positive/HER2-negative breast cancer from an independent cancer centre.• This is independent of patient and pathology parameters and systemic therapy.

Graded Exercise Testing for Risk Stratification of Children and Adolescent Concussion

Graded Exercise Testing for Risk Stratification of Children and Adolescent Concussion

Electrophysiology testing for risk stratification of patients with ischaemic cardiomyopathy: a call for action.

Current guidelines recommendations, based on the results of primary sudden cardiac death prevention trials, use the left ventricular ejection fraction (LVEF) as a sole criterion for the indication of implantable cardioverter defibrillator therapy for primary prevention purposes. In this article, we review the sensitivity and specificity of LVEF for predicting arrhythmic vs. non-arrhythmic cardiac death and examine existing evidence on the use of electrophysiology testing for risk stratification of ischaemic patients with reduced left ventricular function.

Prognostic value of electrocardiogram exercise testing for risk stratification in asymptomatic coronary artery disease.

Several variables of electrocardiogram exercise testing (EET) predict cardiovascular events in the general population and in patients with coronary artery disease (CAD). However, most of the studies have not included patients with asymptomatic CAD. The aim of this study was to evaluate the prognostic value of EET in asymptomatic CAD patients. We carried out a retrospective single-center analysis including all patients with asymptomatic CAD documented by angiography who underwent EET from January 2010 to December 2013. A number of EET variables and three exercise scores [Duke Treadmill Score (DTS), Morise score, and FIT score] were analyzed. The primary endpoint was the combined incidence of myocardial infarction (MI), myocardial revascularization, and death from any cause during follow-up. A total of 306 patients were included (mean age was 65±10 years, 61% had previous MI, and the median exercise capacity was 9.4±2.7 metabolic equivalent of task). The primary endpoint occurred in 15.7% of patients during 3.3 years of follow-up. The DTS and FIT were independent predictors of the primary endpoint unlike the Morise score (DTS: hazard ratio=0.91, 95% confidence interval: 0.85-0.99, P=0.018; FIT score: 0.99, 0.98-0.996, P=0.001; Morise score: 0.97, 0.93-1.02, P=0.20). The DTS was independent predictor of MI or revascularization, whereas FIT predicted death from any cause. Excluding patients with early revascularization, DTS had no predictive power at the composite endpoint. In our population with asymptomatic CAD, FIT and DTS had significant value for risk prediction and consequently the EET can be a valid tool in the clinical follow-up of this population.

Cost-effectiveness of risk stratification tests for the treatment of acute myeloid leukemia in pediatric patients

To estimate the cost-effectiveness of risk-stratification tests for the treatment of acute myeloid leukemia (AML) in pediatric patients. A decision-tree model was built using Life Years Gained as a measure of effectiveness. Costs were estimated considering the perspective of the Colombian health system. Stratification costs included treatment costs based on said stratification. Drug prices were taken from SISMED (Drug Price Information System) 2008 and the monetary value of the procedures was extracted from the ISS 2001 rate manual, plus 30%. All costs were expressed in Colombian pesos for 2010 and the gross domestic product per capita of the same year was used as a cost-effective threshold. Univariate and probabilistic sensitivity analyzes were performed. Risk stratification tests have an incremental cost-effectiveness ratio of COP 8,559,944. These results are sensitive to changes in probabilities of relapse, transplant survival and side effects. Risk stratification tests for AML treatment in pediatric patients are cost-effective in the context of the Colombian health care system.

Physician failure to stratify patients hospitalized with acute pulmonary embolism

ABSTRACTObjectives: In 2011, the AHA recommended risk stratification of patients with acute pulmonary embolism (PE). Failure to risk stratify may cause under recognition of intermediate-risk PE and its attendant short- and long-term consequences. We sought to determine if patients hospitalized with acute PE were appropriately risk stratified according to the 2011 AHA Scientific Statement within our hospital system and whether differences exist in adherence to risk stratification by hospital or treating hospital service. We also wished to know the frequency of in-hospital consultations for acute PE which might assist in the risk stratification process.Methods: This is a retrospective chart audit of all patients hospitalized with a diagnosis of acute PE between January 2011 and December 2013 at our 937-bed metropolitan, three hospital system comprised of academic University, neuroscience Specialty, and teaching Community hospitals. We evaluated the presence of imaging, laboratory tests, and specialty consultation within 72 h of PE diagnosis by hospital.Results: 701 patients with acute PE were admitted to our hospital system during the study period. 308 patients (43.9%) met criteria for intermediate-risk PE. 347 patients (49.5%) were considered ‘Low-Risk – At Risk’, patients defined in a low-risk category not having undergone all recommended risk stratification testing and so truly may have been in a higher risk category. No specialty consultations were utilized for 265 patients (37.8%).Conclusions: Our large metropolitan hospital system inadequately risk stratifies hospitalized patients with acute PE. Because nearly one-half of patients with acute PE did not have all recommended testing, clinicians may be under recognizing patients with intermediate-risk PE and their risk for long-term morbidity. Specialty consultations were underutilized and may help guide medical decision-making.

Febrile infant update.

The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics. There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection. The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.

MP15-20 MCM-2 CELL BASED ASSAY IS A SENSITIVE AND SPECIFIC TEST FOR RISK STRATIFICATION OF BLADDER CANCER PATIENTS.

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2017MP15-20 MCM-2 CELL BASED ASSAY IS A SENSITIVE AND SPECIFIC TEST FOR RISK STRATIFICATION OF BLADDER CANCER PATIENTS. Kasra Saeb-Parsy, Peter Caie, Durgesh Rana, Nadira Narine, Bensita Mary Viju Jose Thottakam, Sushant Dhanvhijay, Andrew Ball, Alexander Wilson, and David Harrison Kasra Saeb-ParsyKasra Saeb-Parsy More articles by this author , Peter CaiePeter Caie More articles by this author , Durgesh RanaDurgesh Rana More articles by this author , Nadira NarineNadira Narine More articles by this author , Bensita Mary Viju Jose ThottakamBensita Mary Viju Jose Thottakam More articles by this author , Sushant DhanvhijaySushant Dhanvhijay More articles by this author , Andrew BallAndrew Ball More articles by this author , Alexander WilsonAlexander Wilson More articles by this author , and David HarrisonDavid Harrison More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.505AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cystoscopy remains the gold standard in the investigation of haematuria and follow up of patients diagnosed with the urothelial carcinoma (UC) of the bladder. There has been extensive research into identifying urinary markers with the aim of improving diagnostic accuracy. Minichromosome maintenance 2 protein (MCM2) is a marker of cell proliferation and ectopic expression is a characteristic feature of malignancy and pre-malignancy.Here we evaluate diagnostic accuracy of MCM2 in diagnosis and surveillance of UC. METHODS A feasibility study was conducted on 176 patients and healthy volunteers from 3 centres in the UK from Cystoscopic Surveillance (CS) and Gross Haematuria (GH) clinics. The verification set comprised 149 volunteers. SurePath platform was used to process the urine cytology samples. Immunocytochemical analysis of MCM2 was performed as a marker for presence of UC. Feasibility data sets were used to determine MCM2 threshold for GH and CS counts using the optimised Youden’s Index (J) and optimal sensitivity, establishing conditions such that there was a zero false negative rate. Cut-off values were used to determine sensitivity, specificity, PPV and NPV. RESULTS Using optimised J-approach, the feasibility sets for GH and CS samples yielded cut-offs of 130 and 81 MCM2 stained cells per slide respectively.The zero false negative approach yielded cut-offs of 44 and 13 MCM2 stained cells for GH and CS patients respectively.Optimised J cut-off yielded sensitivities of 81% in CS group in feasibility and 92.3% in validation with specificities of 80.3 and 94.1% respectively. Corresponding NPV and PPVs ranged from 94.2-96% and 73.9-75.0%. GH sensitivity by optimised J was 87.5 in feasibility and 70.8% in validation sets. Specificities were 92.6 and 95.8% respectively. NPVs were 97.7 and 76.7%, PPVs were 77.8 and 94.4%. Using zero false negative level for cut-off yielded sensitivities close to 100% across all sets, albeit with a concomitant loss of specificity. CONCLUSIONS MCM2 is a reliable non-invasive test, potentially useful in diagnosis of primary and recurrent UC. MCM2 may be used to stratify cases where there is no likelihood of disease i.e. zero false negatives, thus avoiding invasive intervention. In this setting false positives are acceptable as the intervention occurs anyway: the stratification aims to reduce intervention for a large subset of true negatives, resulting in huge health economic benefits plus reduction to morbidity and discomfort associated with flexible cystoscopy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e178 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kasra Saeb-Parsy More articles by this author Peter Caie More articles by this author Durgesh Rana More articles by this author Nadira Narine More articles by this author Bensita Mary Viju Jose Thottakam More articles by this author Sushant Dhanvhijay More articles by this author Andrew Ball More articles by this author Alexander Wilson More articles by this author David Harrison More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Utility of 12-lead and signal-averaged Holter electrocardiograms after pilsicainide provocation for risk stratification in Brugada syndrome.

Non-invasive risk stratification for ventricular fibrillation (VF) in Brugada syndrome (BrS) has not been fully evaluated. The aim of this study was to assess the utility of signal-averaged Holter electrocardiogram (Holter SAECG) and 12-lead Holter electrocardiogram (Holter ECG) after a pilsicainide provocation test for non-invasive risk stratification in BrS. We enrolled 30 consecutive patients with BrS [divided into 2 groups: the VF group, those with a previous history of VF (n = 10); and the non-VF group, those without a history of VF (n = 20)] and 10 control subjects without type 1 ECG. We evaluated late potentials [LP: filtered QRS (f-QRS), RMS40, and LAS40] on the Holter SAECG for 4h after the pilsicainide provocation and in the same patients on another day without performing the pilsicainide provocation. Furthermore, we measured QRS duration and QTc interval in leads V2 and V5, and J amplitude in lead V2 on the Holter ECG after the pilsicainide provocation. On the Holter SAECG, the f-QRS at 1h and LAS40 at 3h after the pilsicainide provocation were significantly larger in the VF group than in the non-VF group (f-QRS at 1h: 113.9 ± 8.9 vs. 104.9 ± 8ms; p = 0.01, LAS40 at 3h: 45.4 ± 5.9 vs. 35.5 ± 7.4ms; p < 0.001). The receiver-operating characteristic curve analysis for a single parameter of VF occurrence was determined [f-QRS at 1h: area under the curve (AUC) 0.8, with sensitivity 80% and specificity 80%; and LAS40 at 3h: AUC 0.87, with sensitivity 90% and specificity 75%]. On the Holter ECG, there were no significant differences in these parameters between the VF and non-VF groups. In conclusion, the LP after the pilsicainide provocation using Holter SAECG may be useful for risk stratification of VF episodes in patients with BrS.

Genetic testing in cardiomyopathies: an update on indications and benefits.

As rapid genetic testing has become increasingly accessible in a timely fashion, more genetic mutations are identified in inherited conditions such as cardiomyopathies. Understanding when to consider genetic testing is an important part of the management of patients whose presentations vary from decompensated heart failure to sudden cardiac death. We describe the benefits of genetic testing for risk stratification of family members, prognostication of probands, and identification of novel disease-causing mutations and examine the possible role of genetic predisposition in seemingly acquired cardiomyopathies such as peripartum and anthracycline-induced cardiomyopathy. Genetic screening for the recognition of family members who have inherited a cardiomyopathy is important, and testing may identify patients at higher risk of sudden death. However, genetic testing does have its limitations, such as the identification of variants of unknown significance that often complicate the clinical picture.

Anomalous Coronary Arteries and Myocardial Bridges: Risk Stratification in Children Using Novel Cardiac Catheterization Techniques.

The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children's Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12-4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6-18.7) years and median weight 49.5 (11.4-142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.

Validation of a Novel Immunoline Assay for Patient Stratification according to Virulence of the Infecting Helicobacter pylori Strain and Eradication Status.

Helicobacter pylori infection shows a worldwide prevalence of around 50%. However, only a minority of infected individuals develop clinical symptoms or diseases. The presence of H. pylori virulence factors, such as CagA and VacA, has been associated with disease development, but assessment of virulence factor presence requires gastric biopsies. Here, we evaluate the H. pylori recomLine test for risk stratification of infected patients by comparing the test score and immune recognition of type I or type II strains defined by the virulence factors CagA, VacA, GroEL, UreA, HcpC, and gGT with patient's disease status according to histology. Moreover, the immune responses of eradicated individuals from two different populations were analysed. Their immune response frequencies and intensities against all antigens except CagA declined below the detection limit. CagA was particularly long lasting in both independent populations. An isolated CagA band often represents past eradication with a likelihood of 88.7%. In addition, a high recomLine score was significantly associated with high-grade gastritis, atrophy, intestinal metaplasia, and gastric cancer. Thus, the recomLine is a sensitive and specific noninvasive test for detecting serum responses against H. pylori in actively infected and eradicated individuals. Moreover, it allows stratifying patients according to their disease state.